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1306275326 NPI number — MIRINDA A BOLTON LPC

NPI Number: 1306275326
Health Care Provider/Practitioner: MIRINDA A BOLTON LPC

Information about “1306275326” NPI (MIRINDA A BOLTON LPC) exists in 1306275326 in HTML format HTML  |  1306275326 in plain Text format TXT  |  1306275326 in PDF (Portable Document Format) PDF  |  1306275326 in an XML format XML  formats.

NPI Number : 1306275326 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1306275326",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BOLTON",
    "FirstName": "MIRINDA",
    "MiddleName": "A",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "914 RICHLAND ST STE B101",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COLUMBIA",
    "MailingAddressStateName": "SC",
    "MailingAddressPostalCode": "29201-2357",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "803-403-8469",
    "MailingAddressFaxNumber": "803-403-9979",
    "FirstLinePracticeLocationAddress": "914 RICHLAND ST STE B101",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLUMBIA",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29201-2357",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "803-403-8469",
    "PracticeLocationAddressFaxNumber": "803-403-9979",
    "EnumerationDate": "11/12/2013",
    "LastUpdateDate": "02/07/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YP2500X",
        "TaxonomyName": "Professional Counselor",
        "LicenseNumber": "5611",
        "LicenseNumberStateCode": "SC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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