MEDICARE: MS. LENORE LOUISE BOLIG LPC

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
1	101YM0800X	Mental Health Counselor	6179	SC

General Provider Information

NPI Number	:	1932629573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LENORE LOUISE BOLIG LPC

Provider Business Mailing Address
First Line	:	2044 N BERWICK DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29575-5801
Country	:	US
Telephone Number	:	843-685-0838
Fax Number	:

Provider Business Practice Location Address
First Line	:	10838 KINGS RD STE 13
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-6070
Country	:	US
Telephone Number	:	843-685-0838
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2017
Last Update Date	:	06/25/2017

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