Boldly Whole, LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

BOLDLY WHOLE, LLC

Practice address

6721 Cathedral Ave
Lanham, MD 20706-3701

Phone

(718) 877-0633

NPI assigned

Apr 19, 2023

Last updated

Apr 19, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Kimberly D Wilson, LICSWNPI 1083036701

Title

Clinical Social Worker

Phone

(718) 877-0633

Specialties & licenses 1

Addresses

Other names 1

• Boldly Whole, LLC Other name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kimberly Wilson, LICSW

  • Clinical Social Worker
  • Hyattsville, MD
  • NPI 1083036701
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681862400000",
    "number": "1386331478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5557 BALTIMORE AVE STE 500-1099",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207811922",
            "telephone_number": "202-858-3816",
            "fax_number": "202-788-6520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6721 CATHEDRAL AVE",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207063701",
            "telephone_number": "718-877-0633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLDLY WHOLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-19",
        "last_updated": "2023-04-19",
        "certification_date": "2023-04-19",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "718-877-0633",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boldly Whole, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Faith Boboye
• Ani Bene Boghossian-James, OTR/L
• Melanie Boguma
• Christa Maria Akfua Boh
• Bernadette Bokone
• Stella Bolle, HHA
• Tracy Teniola Bombata
• Tarrah Bonaparte, LCSW-C
• Bernice Bongo
• Ernest O Bonsu, MS, PA-C

• Adult Mental Health Clinic/Center in Lanham, MD
• Providers in Lanham, MD by specialty
• Adult Mental Health Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.