Provider Demographics
NPI:1932629573
Name:BOLIG, LENORE LOUISE (LPC)
Entity type:Individual
Prefix:MS
First Name:LENORE
Middle Name:LOUISE
Last Name:BOLIG
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 1:2044 N BERWICK DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-5801
Mailing Address - Country:US
Mailing Address - Phone:843-685-0838
Mailing Address - Fax:
Practice Address - Street 1:10838 KINGS RD STE 13
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-6070
Practice Address - Country:US
Practice Address - Phone:843-685-0838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-25
Last Update Date:2017-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6179101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health