Provider Demographics
NPI:1790472413
Name:BOLDEN, RHONDA LEE (LCPC, NCC)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:LEE
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-3836
Mailing Address - Country:US
Mailing Address - Phone:708-743-6836
Mailing Address - Fax:
Practice Address - Street 1:124 E 32ND ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3836
Practice Address - Country:US
Practice Address - Phone:708-743-6836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.015979101YP2500X
IL180.015248101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty