Provider Demographics
NPI:1558105718
Name:BE BOLD THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:BE BOLD THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINN-SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-739-5522
Mailing Address - Street 1:1100 FORT SUMTER CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-3108
Mailing Address - Country:US
Mailing Address - Phone:757-739-5522
Mailing Address - Fax:
Practice Address - Street 1:1100 FORT SUMTER CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-3108
Practice Address - Country:US
Practice Address - Phone:757-739-5522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-22
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty