Provider Demographics
NPI:1699423640
Name:BOLER, LASHUNTA
Entity type:Individual
Prefix:MRS
First Name:LASHUNTA
Middle Name:
Last Name:BOLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF SOCIAL WORK-BHWTP2, GRADUATE SOCIAL WORK
Mailing Address - Street 2:107 MCCALEP-MCINTOSH HALL
Mailing Address - City:NORMAL
Mailing Address - State:AL
Mailing Address - Zip Code:35762
Mailing Address - Country:US
Mailing Address - Phone:205-516-9075
Mailing Address - Fax:205-206-9777
Practice Address - Street 1:DEPARTMENT OF SOCIAL WORK-BHWTP2, GRADUATE SOCIAL WORK
Practice Address - Street 2:107 MCCALEP-MCINTOSH HALL
Practice Address - City:NORMAL
Practice Address - State:AL
Practice Address - Zip Code:35762
Practice Address - Country:US
Practice Address - Phone:205-516-9075
Practice Address - Fax:205-206-9777
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172A00000XOther Service ProvidersDriver