Provider Demographics
NPI:1194555235
Name:BOLGER, DAVIDA HUDSON (LPC)
Entity type:Individual
Prefix:
First Name:DAVIDA
Middle Name:HUDSON
Last Name:BOLGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 OLD YORK RD STE 318
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3709
Mailing Address - Country:US
Mailing Address - Phone:215-885-3337
Mailing Address - Fax:
Practice Address - Street 1:261 OLD YORK RD STE 318
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3709
Practice Address - Country:US
Practice Address - Phone:215-885-3337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC017241101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor