Provider Demographics
NPI:1861822132
Name:BOLD STEP, LLC
Entity Type:Organization
Organization Name:BOLD STEP, LLC
Other - Org Name:BEAUTY FOR ASHES MINISTRIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHEVALENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-826-5979
Mailing Address - Street 1:1121 NW 111TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-7826
Mailing Address - Country:US
Mailing Address - Phone:954-826-5979
Mailing Address - Fax:
Practice Address - Street 1:1121 NW 111TH AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-7826
Practice Address - Country:US
Practice Address - Phone:954-826-5979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW91621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty