Provider Demographics
NPI:1427317700
Name:BOLA, CAROLYN VIRGINIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:VIRGINIA
Last Name:BOLA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 948
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93232-0948
Mailing Address - Country:US
Mailing Address - Phone:559-589-1361
Mailing Address - Fax:
Practice Address - Street 1:4001 KING AVE
Practice Address - Street 2:
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212
Practice Address - Country:US
Practice Address - Phone:559-992-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16230103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic