Individual
MS. KELLY ELIZABETH BOLTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
2250 THUNDERSTICK DR STE 1104, LEXINGTON, KY 40505
(859) 475-8352
Mailing address
360 TULANE DR, LEXINGTON, KY 40517-1534
(859) 270-6356
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
7398
KY
1041C0700X
Clinical Social Worker
Primary
253467
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100556810
—
KY
Enumeration date
06/10/2016
Last updated
10/22/2018
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