Provider Demographics
NPI:1407335797
Name:BOLTON, CARLA (LCMHC, NCC, CCTP)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:BOLTON
Suffix:
Gender:F
Credentials:LCMHC, NCC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 EASTOVER NORTH DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312-3981
Mailing Address - Country:US
Mailing Address - Phone:470-571-6706
Mailing Address - Fax:
Practice Address - Street 1:2813 EASTOVER NORTH DR FAYETTEVILLE NC 28312-6705
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28312
Practice Address - Country:US
Practice Address - Phone:470-571-6706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16811101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty