Provider Demographics
NPI:1366777278
Name:BOLDEN, ANGELA ERIKA LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:ERIKA LEE
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:ERIKA
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3735 FRANKLIN ROAD SW 247
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014
Mailing Address - Country:US
Mailing Address - Phone:540-566-3368
Mailing Address - Fax:
Practice Address - Street 1:541 ELM AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016
Practice Address - Country:US
Practice Address - Phone:540-566-3368
Practice Address - Fax:540-566-3369
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3905103TC1900X, 103TH0100X
VA0810004597103TC1900X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service