Provider Demographics
NPI:1326862285
Name:BOLTON, ERIC SEAN
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:SEAN
Last Name:BOLTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 PENNSYLVANIA ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-6933
Mailing Address - Country:US
Mailing Address - Phone:707-561-2065
Mailing Address - Fax:
Practice Address - Street 1:1145 WARREN AVE
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-7511
Practice Address - Country:US
Practice Address - Phone:707-552-3395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)