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Individual

DORTHIE BOLDEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
7027 BASELINE RD, SOUTH HAVEN, MI 49090-8338
(269) 214-2142
Mailing address
71871 10TH AVE, SOUTH HAVEN, MI 49090-9132
(269) 214-2142

Taxonomy

Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
AS030399514
MI

Other

Enumeration date
09/18/2019
Last updated
09/18/2019
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