Provider Demographics
NPI:1669601985
Name:BOLDT, BETH ANN (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:BOLDT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 SPRING FOREST RD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-9700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:809 SPRING FOREST RD
Practice Address - Street 2:SUITE 1000
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-9700
Practice Address - Country:US
Practice Address - Phone:919-649-5882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0063551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007398Medicaid