Provider Demographics
NPI:1639721384
Name:BOLDEN, CHYNNE KIERRA (LSW, MSW)
Entity Type:Individual
Prefix:
First Name:CHYNNE
Middle Name:KIERRA
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:LSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5574 LEIBOLD DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-3831
Mailing Address - Country:US
Mailing Address - Phone:937-219-0219
Mailing Address - Fax:
Practice Address - Street 1:3541 DAYTON XENIA RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-2824
Practice Address - Country:US
Practice Address - Phone:937-219-0219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1903964104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker