Individual
MR. JAY L BOULTER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LMFT, LPC
Contact information
Practice address
203 CEDARWOOD DR, SALISBURY, NC 28147-9111
(704) 633-3117
(704) 633-3117
Mailing address
203 CEDARWOOD DR, SALISBURY, NC 28147-9111
(704) 633-3117
(704) 633-3117
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
2335
NC
106H00000X
Marriage & Family Therapist
489
NC
106H00000X
Marriage & Family Therapist
Primary
MFC 19316
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1010U
BCBSNC PIN
NC
01
—
118421
VALUE OPTIONS PIN
NC
05
—
1584
—
NC
01
—
34918
CIGNA BEHAVIORAL PIN
NC
01
—
5746163
AETNA PIN
NC
Enumeration date
03/28/2006
Last updated
09/11/2025
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