Provider Demographics
NPI:1891901187
Name:BOLD, ESTHER ABIGAIL (MA, LPC, LADC)
Entity Type:Individual
Prefix:MS
First Name:ESTHER
Middle Name:ABIGAIL
Last Name:BOLD
Suffix:
Gender:F
Credentials:MA, LPC, LADC
Other - Prefix:MS
Other - First Name:ESTHER
Other - Middle Name:ABIGAIL
Other - Last Name:BOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC, LADC
Mailing Address - Street 1:PO BOX 2104
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-2104
Mailing Address - Country:US
Mailing Address - Phone:405-757-7696
Mailing Address - Fax:
Practice Address - Street 1:1818 E REZANOF DR
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6505
Practice Address - Country:US
Practice Address - Phone:405-757-7696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1063101YA0400X
OK5008101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200374260AMedicaid