| Doctor Name: | MS. TRACYANN MARIE SPAULDING BOLSTRIDGE |
| NPI Number: | 1043644123 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 002277 |
| Business Practice Address: | 58 Missionary Rd Cromwell, CT - 064162134 |
| Business Phone Number: | 8606356010 |
| Business Fax Number: | |
| Mailing Address: | 58 Missionary Rd, CROMWELL |
| State: | CT |
| Postal Code: | 064162134 |
| Phone Number: | 8606356010 |
| Fax Number: | |
| NPI Enumeration Date: | 08/26/2013 |
| NPI Last Update Date: | 08/26/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 002277 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |