Provider Demographics
NPI:1710712997
Name:BOLDBRAVEFEARLESS COUNSELING AND CONSULTING LLC
Entity type:Organization
Organization Name:BOLDBRAVEFEARLESS COUNSELING AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICKISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-883-6605
Mailing Address - Street 1:58 WARD PL APT 1A
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-3096
Mailing Address - Country:US
Mailing Address - Phone:860-883-6605
Mailing Address - Fax:
Practice Address - Street 1:58 WARD PL APT 1A
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3096
Practice Address - Country:US
Practice Address - Phone:860-883-6605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty