Provider Demographics
NPI:1629153812
Name:HONEA BOLES, PATRICIA ROSE (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ROSE
Last Name:HONEA BOLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 154437
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75915-4437
Mailing Address - Country:US
Mailing Address - Phone:936-639-3233
Mailing Address - Fax:936-639-3680
Practice Address - Street 1:600 S JOHN REDDITT DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3121
Practice Address - Country:US
Practice Address - Phone:936-639-3233
Practice Address - Fax:936-639-3680
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX184271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0006DGOtherBLUE CROSS BLUE SHIELD TX
0007399046OtherAETNA
126788OtherVALUE OPTIONS
485484OtherMAGELLAN
126788OtherVALUE OPTIONS