Provider Demographics
NPI:1588191860
Name:BOLDEN, TRAMENIA SHAVON (MS)
Entity type:Individual
Prefix:
First Name:TRAMENIA
Middle Name:SHAVON
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 GENERAL GARDNER AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-7824
Mailing Address - Country:US
Mailing Address - Phone:337-232-9457
Mailing Address - Fax:337-232-9459
Practice Address - Street 1:202 GENERAL GARDNER AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-7824
Practice Address - Country:US
Practice Address - Phone:337-232-9457
Practice Address - Fax:337-232-9459
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X
LA8182101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator