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NPI Code Detail

MEDICARE: MARC BOLLINGER LICSW

MEDICARE: MARC BOLLINGER LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLW00007719WA

General Provider Information

NPI Number : 1932267283
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARC BOLLINGER LICSW
Provider Business Mailing Address
First Line : 2106 SYCAMORE PL
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-4525
Country : US
Telephone Number : 360-431-2042
Fax Number :
Provider Business Practice Location Address
First Line : 921 14TH AVE
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-2316
Country : US
Telephone Number : 360-423-0203
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2006
Last Update Date : 09/27/2024

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Directions to “ MARC BOLLINGER LICSW” Practice Location

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