Provider Demographics
NPI:1659801298
Name:BOLDS-HANNS, ASIA
Entity Type:Individual
Prefix:
First Name:ASIA
Middle Name:
Last Name:BOLDS-HANNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4334 W CENTRAL AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1679
Mailing Address - Country:US
Mailing Address - Phone:419-407-6113
Mailing Address - Fax:
Practice Address - Street 1:4334 W CENTRAL AVE STE 202
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1679
Practice Address - Country:US
Practice Address - Phone:419-407-6113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1902026101YM0800X
172V00000X
OHE.2202726101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0349118Medicaid
OH0389503Medicaid