Provider Demographics
NPI:1083017529
Name:BOLAR, DONIQUE (BCBA)
Entity type:Individual
Prefix:MR
First Name:DONIQUE
Middle Name:
Last Name:BOLAR
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 N STATE ROAD 7 STE 300
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5867
Mailing Address - Country:US
Mailing Address - Phone:561-323-6593
Mailing Address - Fax:
Practice Address - Street 1:3098 PIEDMONT RD NE STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2600
Practice Address - Country:US
Practice Address - Phone:561-210-3264
Practice Address - Fax:561-210-5500
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2021-032103K00000X, 103K00000X
GA1-21-49013103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst