Provider Demographics
NPI:1851919021
Name:BOLDEN, SHAMEKA HYLTON (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHAMEKA
Middle Name:HYLTON
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:SHAMEKA
Other - Middle Name:NICOLE
Other - Last Name:HYLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 NEWCOMB ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-1324
Mailing Address - Country:US
Mailing Address - Phone:276-618-2731
Mailing Address - Fax:
Practice Address - Street 1:350 NEWCOMB ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-1324
Practice Address - Country:US
Practice Address - Phone:276-618-2731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008827101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional