Provider Demographics
NPI:1841916251
Name:BOLDEN, CHARIA MONIQUE (CNA)
Entity type:Individual
Prefix:
First Name:CHARIA
Middle Name:MONIQUE
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E PARK AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-9102
Mailing Address - Country:US
Mailing Address - Phone:630-803-5682
Mailing Address - Fax:
Practice Address - Street 1:309 WALNUT ST STE B
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2766
Practice Address - Country:US
Practice Address - Phone:703-564-1634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106S00000X106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician