MEDICARE: INDIA MONAYE BOLDEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	A20933	NC

General Provider Information

NPI Number	:	1225843279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INDIA MONAYE BOLDEN

Provider Business Mailing Address
First Line	:	4105 HUNTSMOOR LN
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27896-8695
Country	:	US
Telephone Number	:	252-290-7618
Fax Number	:

Provider Business Practice Location Address
First Line	:	58 AZIMUTH CT
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-3102
Country	:	US
Telephone Number	:	252-231-1341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2025
Last Update Date	:	02/07/2025

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Directions to “ INDIA MONAYE BOLDEN ” Practice Location

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