Healthcare Provider Details

I. General information

NPI: 1902431133
Provider Name (Legal Business Name): MONICA BOLTON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 PARKER ST STE 306
MAYNARD MA
01754-2180
US

IV. Provider business mailing address

7216 CREEKVIEW DR APT 9
CINCINNATI OH
45247-2588
US

V. Phone/Fax

Practice location:
  • Phone: 866-201-6361
  • Fax:
Mailing address:
  • Phone: 513-550-0560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number39004513A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2203010-SUPV
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number279235
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2203010-SUPV
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2942
License Number StateWV
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number279235
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: