Provider Demographics
NPI:1831571991
Name:BOULDIN, SASHA VENYKE (LCSW-A)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:VENYKE
Last Name:BOULDIN
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 TRINITY GATE LN APT 308
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-3997
Mailing Address - Country:US
Mailing Address - Phone:919-610-6284
Mailing Address - Fax:
Practice Address - Street 1:3000 HIGHWOODS BLVD STE 301
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1029
Practice Address - Country:US
Practice Address - Phone:919-610-6284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0089981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical