Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | LPC007720 | GA |
N | 101YM0800X | Mental Health Counselor | LPC007720 | GA |
Y | 101YP2500X | Professional Counselor | LPC007720 | GA |
N | 102L00000X | Psychologist | LPC007720 | GA |
N | 103T00000X | Psychologist | LPC007720 | GA |
NPI | 1013334713 |
---|---|
Provider Name | Emily Bolton |
First Address | Rome, GA 30165-4021 |
Second Address | Rome, GA 30165-4021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2014 |
Last Update Date | 20/03/2014 |