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General NPI Number Information
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NPI Number | 1932126729
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Entity Type | Individual
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Provider Name | JOHN B BOLTZ MSW
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Gender | Male
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 08/09/2007
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Provider Practice Location Address
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Address Line | 107 NORTH POND ROAD
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City | GREENWOOD
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State | SC
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Zip | 29649-9713
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Country | US
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Telephone | 864-943-3325
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Fax |
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Provider Business Mailing Address
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Address Line | 107 N POND CT
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City | GREENWOOD
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State | SC
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Zip | 29649-9713
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Country | US
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Telephone | 864-943-3325
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6246
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License Number State | SC
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