Provider Demographics
NPI:1700412392
Name:BOLTON, LATOYA A (LPC)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:A
Last Name:BOLTON
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 1:3966 BRONX BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-3504
Mailing Address - Country:US
Mailing Address - Phone:646-391-1377
Mailing Address - Fax:
Practice Address - Street 1:3966 BRONX BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-3504
Practice Address - Country:US
Practice Address - Phone:646-391-1377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health