Provider Demographics
NPI:1255094348
Name:BOLDEN, BRITTANY (LMFTA)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 CHESTNUT LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-6085
Mailing Address - Country:US
Mailing Address - Phone:704-576-6226
Mailing Address - Fax:
Practice Address - Street 1:4726 PARK RD STE C
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3375
Practice Address - Country:US
Practice Address - Phone:704-576-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12301A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist