Provider Demographics
NPI:1740620962
Name:BOLIN, SARAH BETH (LCSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:BETH
Last Name:BOLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 HAYS ST STE E
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:TX
Mailing Address - Zip Code:78648-3207
Mailing Address - Country:US
Mailing Address - Phone:830-875-7046
Mailing Address - Fax:830-875-6151
Practice Address - Street 1:130 HAYS ST STE E
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:TX
Practice Address - Zip Code:78648-3207
Practice Address - Country:US
Practice Address - Phone:830-875-7046
Practice Address - Fax:830-875-6151
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57287101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX065337001Medicaid