Provider Demographics
NPI:1497536122
Name:BOLD EXPRESSIONS THERAPY
Entity Type:Organization
Organization Name:BOLD EXPRESSIONS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARFORI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:803-466-5242
Mailing Address - Street 1:2226 DECATUR PL NW APT 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-4008
Mailing Address - Country:US
Mailing Address - Phone:803-466-5242
Mailing Address - Fax:
Practice Address - Street 1:2226 DECATUR PL NW APT 2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-4008
Practice Address - Country:US
Practice Address - Phone:803-466-5242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty