| NPI | 1386331478 |
|---|---|
| Other Name | BOLDLY WHOLE, LLC |
| Entity Type | Organization |
| Authorized Contact | KIMBERLY D WILSON Clinical Social Worker 718-877-0633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2023-04-19 |
| Last Update Date | 2023-04-19 |