Provider Demographics
NPI:1073861886
Name:BOLDEN, DAPHNE RUTH (APRN PMH CNS)
Entity Type:Individual
Prefix:MS
First Name:DAPHNE
Middle Name:RUTH
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:APRN PMH CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1938 WINDER RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1729
Mailing Address - Country:US
Mailing Address - Phone:410-298-2609
Mailing Address - Fax:
Practice Address - Street 1:1938 WINDER RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-1729
Practice Address - Country:US
Practice Address - Phone:410-298-2609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR087909101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health