Provider Demographics
NPI:1407511660
Name:BOLDEN THERAPY & WELLNESS, LLC
Entity Type:Organization
Organization Name:BOLDEN THERAPY & WELLNESS, LLC
Other - Org Name:SHAMEKA BOLDEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:540-880-2208
Mailing Address - Street 1:2000 KRAFT DR STE 1300
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-6162
Mailing Address - Country:US
Mailing Address - Phone:540-880-2208
Mailing Address - Fax:540-866-0868
Practice Address - Street 1:2000 KRAFT DR STE 1300
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6162
Practice Address - Country:US
Practice Address - Phone:540-880-2208
Practice Address - Fax:540-866-0868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health