Provider Demographics
NPI:1942584677
Name:BOLTON, TANYA EVETTE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:EVETTE
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 1:810 DUTCH SQUARE BLVD STE 460
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-7327
Mailing Address - Country:US
Mailing Address - Phone:803-447-3230
Mailing Address - Fax:803-798-7541
Practice Address - Street 1:5000 THURMOND MALL
Practice Address - Street 2:SUITE 309
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201
Practice Address - Country:US
Practice Address - Phone:803-252-7952
Practice Address - Fax:803-252-7953
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4603101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional