Provider Demographics
NPI:1114783792
Name:ANGEL OAK PSYCHIATRY, LLC
Entity Type:Organization
Organization Name:ANGEL OAK PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LETITIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-941-7635
Mailing Address - Street 1:6701 DEMOCRACY BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-7500
Mailing Address - Country:US
Mailing Address - Phone:301-941-7635
Mailing Address - Fax:
Practice Address - Street 1:6701 DEMOCRACY BLVD STE 300
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-7500
Practice Address - Country:US
Practice Address - Phone:301-941-7635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty