Provider Demographics
NPI:1417341876
Name:BOLDEN, VERNETTA (LPC)
Entity Type:Individual
Prefix:DR
First Name:VERNETTA
Middle Name:
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 PARKS BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-3243
Mailing Address - Country:US
Mailing Address - Phone:601-624-1524
Mailing Address - Fax:
Practice Address - Street 1:1116 PARKS BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-3243
Practice Address - Country:US
Practice Address - Phone:601-624-1524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1825101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional