Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2289 | WV |
NPI | 1003328857 |
---|---|
Provider Name | Mrs. Leslie Erin Bolock |
First Address | Wheeling, WV 26003-5370 |
Second Address | Wheeling, WV 26003-5370 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2017 |
Last Update Date | 02/11/2017 |