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NPI Code Detail

MEDICARE: DAVID BOLTON M.ED., LPC

MEDICARE: DAVID BOLTON M.ED., LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor906NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
116497OTHERNCBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427101617
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID BOLTON M.ED., LPC
Provider Business Mailing Address
First Line : 405 BLANDWOOD AVE.
Second Line :
City : GREENSBORO
State : NC
Zip : 27401
Country : US
Telephone Number : 336-389-1413
Fax Number : 336-389-1416
Provider Business Practice Location Address
First Line : 12 N 5TH AVE
Second Line :
City : WILMINGTON
State : NC
Zip : 28401-4537
Country : US
Telephone Number : 910-765-1003
Fax Number : 910-765-1004
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2007
Last Update Date : 08/24/2023

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