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General NPI Number Information
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NPI Number | 1366783938
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Entity Type | Individual
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Provider Name | DEANNE RENEE' BOLDEN LMSW
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Gender | Female
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Dates
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Enumeration Date | 03/07/2013
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 17515 W 9 MILE RD STE 755
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4422
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Country | US
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Telephone | 248-499-4312
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Fax | 248-721-4936
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Provider Business Mailing Address
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Address Line | 29323 CANDLEWOOD LN
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City | SOUTHFIELD
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State | MI
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Zip | 48076-1867
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Country | US
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Telephone | 248-445-1801
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Fax | 313-251-2774
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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 | 6801093858
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License Number State | MI
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