Provider Demographics
NPI:1730957929
Name:BOLLIG, AVA
Entity type:Individual
Prefix:MISS
First Name:AVA
Middle Name:
Last Name:BOLLIG
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 1:52 HOPKINS RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:CT
Mailing Address - Zip Code:06281-2724
Mailing Address - Country:US
Mailing Address - Phone:860-455-8301
Mailing Address - Fax:
Practice Address - Street 1:42 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-1937
Practice Address - Country:US
Practice Address - Phone:508-205-9272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician