Diane Bradford Bolster, MSW, LCSWA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

PO21183 Issued in NC

Practice address

121 Rolling Hill Rd Ste 225
Mooresville, NC 28117-8861

Phone

(704) 737-2109

NPI assigned

Aug 21, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746748800000",
    "number": "1104659630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 ROLLING HILL RD STE 225",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178861",
            "telephone_number": "980-505-7712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 ROLLING HILL RD STE 225",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178861",
            "telephone_number": "704-737-2109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLSTER",
        "first_name": "DIANE",
        "middle_name": "BRADFORD",
        "credential": "MSW, LCSWA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-21",
        "last_updated": "2025-05-09",
        "certification_date": "2025-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "PO21183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martin L Blue, MD
• Olivia Kathleen Bockenstedt
• Robert M Bodajla
• Rosario Walter Bogart, CRNA
• Nikki Bolick
• Lauren Ashley Bonasso, MOT, OTR/L
• Danielle Bonnevie, M.ED., BCBA
• Shawn Booth, LCMHC
• Jennifer Borst
• Matthew Joseph Boss, MD

• Clinical Social Worker in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.