Provider Demographics
NPI:1073850657
Name:BOLDEN, SONYA (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CENTURY PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-8136
Mailing Address - Country:US
Mailing Address - Phone:972-516-4320
Mailing Address - Fax:844-402-0972
Practice Address - Street 1:450 CENTURY PKWY STE 250
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-8136
Practice Address - Country:US
Practice Address - Phone:972-516-4320
Practice Address - Fax:844-402-0972
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2021-12-29
Deactivation Date:2020-02-18
Deactivation Code:
Reactivation Date:2021-12-06
Provider Licenses
StateLicense IDTaxonomies
IL149.0153621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical