Individual
IYANA ROSE BOLDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1237 AUGUSTA WEST PKWY, AUGUSTA, GA 30909-1807
(762) 685-4340
Mailing address
300 INTERNATIONAL PKWY STE 200, LAKE MARY, FL 32746-5028
(866) 610-0580
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/01/2023
Last updated
11/01/2023
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