Individual
AQUEELAH F BOLDEN-MCCOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSS
Contact information
Practice address
620 NE 2ND ST, GRESHAM, OR 97030
(971) 274-3757
(503) 912-5740
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205
(503) 224-1044
(503) 621-2235
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
CG60487815
WA
101YM0800X
Mental Health Counselor
Primary
THW000002697
OR
101YM0800X
Mental Health Counselor
—
OR
Other
Enumeration date
05/06/2015
Last updated
04/13/2018
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