Provider Demographics
NPI:1316404544
Name:BOLD RULER, LLC
Entity Type:Organization
Organization Name:BOLD RULER, LLC
Other - Org Name:SUMMIT COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MALONEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT
Authorized Official - Phone:757-472-1379
Mailing Address - Street 1:208 BURLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3413
Mailing Address - Country:US
Mailing Address - Phone:757-472-1379
Mailing Address - Fax:
Practice Address - Street 1:821 W 21ST ST STE 209
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1500
Practice Address - Country:US
Practice Address - Phone:757-280-1777
Practice Address - Fax:757-585-3521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-24
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010001625Medicaid
VA0701003466OtherLPC
VA0717001169OtherLMFT