Provider Demographics
NPI:1144872003
Name:BOULDIN, EDYTHE MARIE (LPC)
Entity type:Individual
Prefix:
First Name:EDYTHE
Middle Name:MARIE
Last Name:BOULDIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 WILLIAMSBURG RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-1825
Mailing Address - Country:US
Mailing Address - Phone:804-647-5564
Mailing Address - Fax:
Practice Address - Street 1:2301 WILLIAMSBURG RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-1825
Practice Address - Country:US
Practice Address - Phone:804-647-5564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional