Provider Demographics
NPI:1821340134
Name:BOLTON, RACHAEL (MA)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:BOLTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:MADDEN-CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 TECH CENTER DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-2747
Mailing Address - Country:US
Mailing Address - Phone:865-637-9111
Mailing Address - Fax:
Practice Address - Street 1:3712 MIDDLEBROOK PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-6503
Practice Address - Country:US
Practice Address - Phone:865-444-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH0157Medicaid
AKMH0157Medicaid