Provider Demographics
NPI:1306313101
Name:BOLTON, KARLTON S (LADAC II)
Entity type:Individual
Prefix:MR
First Name:KARLTON
Middle Name:S
Last Name:BOLTON
Suffix:
Gender:M
Credentials:LADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 W EASTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-3531
Mailing Address - Country:US
Mailing Address - Phone:615-428-6148
Mailing Address - Fax:
Practice Address - Street 1:45 RUTLEDGE ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-2042
Practice Address - Country:US
Practice Address - Phone:615-428-6148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1308101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty