Fannie Bolden, AT

NPI #1558518928 in Lake Village, Arkansas

Provider Information

NPI Number: 1558518928
Entity Type: Individual
Name: Fannie Bolden, AT
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Counselor
Credential: AT
Enumeration Date: Aug 27, 2008
Last Updated: Aug 27, 2008

Practice Location

Address: 608 S HIGHWAY 65 82
Address 2: STE B
City: Lake Village
State: Arkansas
ZIP Code: 71653-1743
Phone: (870) 265-3711

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor	101Y00000X	Primary

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