Provider Demographics
NPI:1386367001
Name:BOLDEN, ANTONIO M (LPC)
Entity type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:M
Last Name:BOLDEN
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 HUFF HERITAGE LN
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-3897
Mailing Address - Country:US
Mailing Address - Phone:540-392-9228
Mailing Address - Fax:
Practice Address - Street 1:2000 KRAFT DR STE 1300
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6162
Practice Address - Country:US
Practice Address - Phone:540-392-9228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011811101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional