Provider Demographics
NPI:1902550080
Name:BOLANDER, LOGAN J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:LOGAN
Middle Name:J
Last Name:BOLANDER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-8334
Mailing Address - Country:US
Mailing Address - Phone:302-598-8722
Mailing Address - Fax:
Practice Address - Street 1:1301 E 12TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-5315
Practice Address - Country:US
Practice Address - Phone:302-429-7731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00118721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical