Provider Demographics
NPI:1790096287
Name:BOLDING, CASSANDRA RENEE (LPC)
Entity Type:Individual
Prefix:MISS
First Name:CASSANDRA
Middle Name:RENEE
Last Name:BOLDING
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W ABBOTTSFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-3612
Mailing Address - Country:US
Mailing Address - Phone:215-796-8864
Mailing Address - Fax:
Practice Address - Street 1:150 W ABBOTTSFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-3612
Practice Address - Country:US
Practice Address - Phone:215-796-8864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005525101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional