Provider Demographics
NPI:1396499299
Name:BOLDUC, SARAH LEANN (CIT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LEANN
Last Name:BOLDUC
Suffix:
Gender:F
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 S ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-3741
Mailing Address - Country:US
Mailing Address - Phone:479-705-0118
Mailing Address - Fax:
Practice Address - Street 1:313 S ROGERS ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-3741
Practice Address - Country:US
Practice Address - Phone:479-705-0118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARCIT101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)