Provider Demographics
NPI:1629531736
Name:BOLDEN, UNIQUE C (LCPC)
Entity Type:Individual
Prefix:MS
First Name:UNIQUE
Middle Name:C
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MRS
Other - First Name:UNIQUE
Other - Middle Name:C
Other - Last Name:CASTELLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:107 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5213
Mailing Address - Country:US
Mailing Address - Phone:410-558-0032
Mailing Address - Fax:
Practice Address - Street 1:10770 COLUMBIA PIKE STE 300
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4439
Practice Address - Country:US
Practice Address - Phone:470-927-5466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
LC12716101YM0800X
MDLGP9355101YP2500X
MDLC12716101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health