Healthcare Provider Details

I. General information

NPI: 1275519308
Provider Name (Legal Business Name): CYNTHIA J BOLT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 PINE ST
ARKADELPHIA AR
71923-4358
US

IV. Provider business mailing address

612 POSEY RD
SPARKMAN AR
71763-8812
US

V. Phone/Fax

Practice location:
  • Phone: 870-210-6776
  • Fax:
Mailing address:
  • Phone: 870-210-6776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1352-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: