Bolanle Fanilola, LMSW
Individual provider Active NPI Social Worker · Richmond, VA
NPI 1043845910 · NPPES record last updated Mar 11, 2020
Key facts
- NPI
- 1043845910
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 0903002957 (VA)
- Practice address
- 681 Hioaks Rd Ste J
Richmond, VA 23225-4043 - Phone
- (804) 533-1330
- NPI assigned
- Mar 11, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22958 | MD | MD | Social Worker |
| 0903002957 | VA | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Leesburg Treatment Services, LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 22958 | MD | |
| Social Worker | 104100000X | 0903002957 | VA | Yes |
Addresses
Primary practice location
681 Hioaks Rd Ste J
Richmond, VA 23225-4043
Mailing address
10100 Palace Way Apt B
Henrico, VA 23238-5646
Phone (443) 416-9572
Other providers in Richmond, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 11, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.