Provider Demographics
NPI:1578879011
Name:BOLTON, NOVETA ANN (MS)
Entity Type:Individual
Prefix:MS
First Name:NOVETA
Middle Name:ANN
Last Name:BOLTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 23RD. AVE. S.
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407
Mailing Address - Country:US
Mailing Address - Phone:612-298-3524
Mailing Address - Fax:
Practice Address - Street 1:7575 GOLDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4562
Practice Address - Country:US
Practice Address - Phone:612-298-3524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-22
Last Update Date:2010-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1471101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health