Basic Information
| Provider Information | |||||||||
| NPI: | 1750801189 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOLTON | ||||||||
| FirstName: | DAYNA | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMHC | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 914 N CANAL ST | ||||||||
| Address2: | |||||||||
| City: | CARLSBAD | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882205110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5758854836 | ||||||||
| FaxNumber: | 5756280676 | ||||||||
| Practice Location | |||||||||
| Address1: | 914 N CANAL ST | ||||||||
| Address2: | |||||||||
| City: | CARLSBAD | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882205110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5758854836 | ||||||||
| FaxNumber: | 5756280676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 07/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YM0800X | T-CTL0215521 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.