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General NPI Number Information
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NPI Number | 1174200018
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Entity Type | Individual
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Provider Name | MICAH BOLDEN LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/03/2023
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Last Update Date | 08/30/2025
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Provider Practice Location Address
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Address Line | 8204 ELMBROOK DR STE 260
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City | DALLAS
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State | TX
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Zip | 75247-4067
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Country | US
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Telephone | 214-351-1775
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Fax |
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Provider Business Mailing Address
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Address Line | 1139 HAINES AVE
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City | DALLAS
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State | TX
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Zip | 75208-4042
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Country | US
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Telephone | 706-333-3426
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW.09932236
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 107915
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License Number State | TX
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