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General NPI Number Information
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NPI Number | 1306275326
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Entity Type | Individual
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Provider Name | MIRINDA A BOLTON LPC
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Gender | Female
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Dates
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Enumeration Date | 11/12/2013
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 914 RICHLAND ST STE B101
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City | COLUMBIA
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State | SC
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Zip | 29201-2357
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Country | US
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Telephone | 803-403-8469
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Fax | 803-403-9979
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Provider Business Mailing Address
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Address Line | 914 RICHLAND ST STE B101
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City | COLUMBIA
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State | SC
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Zip | 29201-2357
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Country | US
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Telephone | 803-403-8469
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Fax | 803-403-9979
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5611
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License Number State | SC
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