Provider Demographics
NPI:1043644123
Name:SPAULDING BOLSTRIDGE, TRACYANN MARIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:TRACYANN
Middle Name:MARIE
Last Name:SPAULDING BOLSTRIDGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 MISSIONARY RD
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2134
Mailing Address - Country:US
Mailing Address - Phone:860-635-6010
Mailing Address - Fax:
Practice Address - Street 1:58 MISSIONARY RD
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2134
Practice Address - Country:US
Practice Address - Phone:860-635-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002277101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health