Provider Demographics
NPI:1831364645
Name:BOLING, LEAH BOTONA (EDS, LPC, LMFT)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:BOTONA
Last Name:BOLING
Suffix:
Gender:F
Credentials:EDS, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 LINAPUNI STREET, SUITE 105
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-3575
Mailing Address - Country:US
Mailing Address - Phone:808-843-5312
Mailing Address - Fax:808-848-2069
Practice Address - Street 1:1485 LINAPUNI STREET, SUITE 105
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-3575
Practice Address - Country:US
Practice Address - Phone:808-843-5312
Practice Address - Fax:808-848-2069
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2387101YP2500X
VA0717000088106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional