Provider Demographics
NPI:1083437479
Name:BOLEN, MICHAEL A (NCC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:BOLEN
Suffix:
Gender:M
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1524
Mailing Address - Country:US
Mailing Address - Phone:908-380-6307
Mailing Address - Fax:
Practice Address - Street 1:111 NJ-35
Practice Address - Street 2:
Practice Address - City:CLIFFWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07721
Practice Address - Country:US
Practice Address - Phone:732-812-5489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)