Provider Demographics
NPI:1336291947
Name:BOLTE, MARK E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:BOLTE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WHEATSTONE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9029
Mailing Address - Country:US
Mailing Address - Phone:803-699-8193
Mailing Address - Fax:
Practice Address - Street 1:1903 GADSDEN ST
Practice Address - Street 2:PALMETTO COUNSELING ASSOCIATES, LLC
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2346
Practice Address - Country:US
Practice Address - Phone:803-254-9767
Practice Address - Fax:803-254-9740
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC706103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical