Provider Demographics
NPI:1316770746
Name:BOLLING, ALEXIS ADRIANA LEE (LCSW)
Entity type:Individual
Prefix:MISS
First Name:ALEXIS
Middle Name:ADRIANA LEE
Last Name:BOLLING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 FOREST GREEN RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-8102
Mailing Address - Country:US
Mailing Address - Phone:352-792-4153
Mailing Address - Fax:
Practice Address - Street 1:6025 FOREST GREEN RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-8102
Practice Address - Country:US
Practice Address - Phone:352-792-4153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW23240101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional