| Doctor Name: | MARY BOLTON-OWENS |
| NPI Number: | 1023198975 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.P.C. |
| License Number: | 0701003162 |
| Business Practice Address: | 12359 Sunrise Valley Dr Suite 220 Reston, VA - 201913462 |
| Business Phone Number: | 3016209762 |
| Business Fax Number: | |
| Mailing Address: | 4312 Markwood Ln, FAIRFAX |
| State: | VA |
| Postal Code: | 220333638 |
| Phone Number: | 3012609762 |
| Fax Number: | |
| NPI Enumeration Date: | 10/16/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 0701003162 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |