Provider Demographics
NPI:1033789102
Name:BOLDEN-SMITH, PATRINIA D (MSW)
Entity Type:Individual
Prefix:MRS
First Name:PATRINIA
Middle Name:D
Last Name:BOLDEN-SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 LEE ROAD 2104
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36804-2089
Mailing Address - Country:US
Mailing Address - Phone:662-422-6747
Mailing Address - Fax:
Practice Address - Street 1:143 LEE ROAD 2104
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36804-2089
Practice Address - Country:US
Practice Address - Phone:662-422-6747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor