Healthcare Provider Details

I. General information

NPI: 1629531736
Provider Name (Legal Business Name): UNIQUE C. BOLDEN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. UNIQUE C CASTELLE

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10770 COLUMBIA PIKE STE 300
SILVER SPRING MD
20901-4439
US

IV. Provider business mailing address

107 E 25TH ST
BALTIMORE MD
21218-5213
US

V. Phone/Fax

Practice location:
  • Phone: 470-927-5466
  • Fax:
Mailing address:
  • Phone: 410-558-0032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC12716
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP9355
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC12716
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: