Basic Information
| Provider Information | |||||||||
| NPI: | 1427317700 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOLA | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | VIRGINIA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 948 | ||||||||
| Address2: | |||||||||
| City: | HANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932320948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595891361 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4001 KING AVE | ||||||||
| Address2: | |||||||||
| City: | CORCORAN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5599928800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2012 | ||||||||
| LastUpdateDate: | 05/08/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TF0200X | PSY16230 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Forensic |
No ID Information.