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General NPI Number Information
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NPI Number | 1851181028
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Entity Type | Individual
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Provider Name | DEAN MICHAEL BOLT
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Gender | Male
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Dates
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Enumeration Date | 05/09/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 2124 MARTIN LUTHER KING JR AVE SE
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City | WASHINGTON
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State | DC
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Zip | 20020-5732
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Country | US
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Telephone | 202-563-7632
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Fax |
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Provider Business Mailing Address
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Address Line | 13109 FOREST DR
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City | BOWIE
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State | MD
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Zip | 20715-4396
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Country | US
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Telephone | 240-281-3608
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Fax |
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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 | LGPC200001921
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License Number State | DC
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