Individual
MRS. SHANNON BOLTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC, IADC, PCDGC
Contact information
Practice address
108 N 49TH ST STE B103, OMAHA, NE 68132-3172
(402) 200-3808
Mailing address
108 N 49TH ST STE B103, OMAHA, NE 68132-3172
(402) 200-3808
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1439
NE
101YA0400X
Addiction (Substance Use Disorder) Counselor
22R101
IA
101YA0400X
Addiction (Substance Use Disorder) Counselor
51
NE
Other
Enumeration date
03/03/2020
Last updated
11/14/2024
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