Provider Demographics
NPI:1962136358
Name:BOLDEN, ROLANDA NATASHA
Entity type:Individual
Prefix:MS
First Name:ROLANDA
Middle Name:NATASHA
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 PRESTON RD APT 1424
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2548
Mailing Address - Country:US
Mailing Address - Phone:773-803-0209
Mailing Address - Fax:
Practice Address - Street 1:3010 LEGACY DR STE 220
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-7339
Practice Address - Country:US
Practice Address - Phone:469-840-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15283101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)