Provider Demographics
NPI:1275519308
Name:BOLT, CYNTHIA J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:J
Last Name:BOLT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 POSEY RD
Mailing Address - Street 2:
Mailing Address - City:SPARKMAN
Mailing Address - State:AR
Mailing Address - Zip Code:71763-8812
Mailing Address - Country:US
Mailing Address - Phone:870-210-6776
Mailing Address - Fax:
Practice Address - Street 1:2503 PINE ST
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-4358
Practice Address - Country:US
Practice Address - Phone:870-210-6776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1352-C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
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AR7997125OtherAETNA INSURANCE COMPANY
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AR108585OtherUNITED BEHAVIORAL HEALTH
AR5U127OtherAR. BLUE CROSS & BS