Provider Demographics
NPI:1871322941
Name:BOLSTER, LAURIE (MA, LCHMCA)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:
Last Name:BOLSTER
Suffix:
Gender:F
Credentials:MA, LCHMCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 NORRIS ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-2029
Mailing Address - Country:US
Mailing Address - Phone:919-247-0308
Mailing Address - Fax:
Practice Address - Street 1:2121 TW ALEXANDER DR STE 124-55
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6815
Practice Address - Country:US
Practice Address - Phone:910-446-9844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17344101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health