| Boldly Whole, LLC | |
|
6721 Cathedral Ave Lanham MD 20706-3701 | |
| (718) 877-0633 | |
| Not Available |
| Full Name | Boldly Whole, LLC |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 6721 Cathedral Ave, Lanham, Maryland |
| Authorized Official Name and Position | Kimberly D Wilson (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 7188770633 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Boldly Whole, LLC 5557 Baltimore Ave Ste 500-1099 Hyattsville MD 20781-1922 Ph: (202) 858-3816 | Boldly Whole, LLC 6721 Cathedral Ave Lanham MD 20706-3701 Ph: (718) 877-0633 |
| NPI Number | 1386331478 |
|---|---|
| Provider Enumeration Date | 04/19/2023 |
| Last Update Date | 04/19/2023 |
| Certification Date | 04/19/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386331478 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (NU) | Primary |
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