Provider Demographics
NPI:1053049205
Name:BOULDEN, JOHNPAUL C (MED, LPC)
Entity type:Individual
Prefix:
First Name:JOHNPAUL
Middle Name:C
Last Name:BOULDEN
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 PARIS AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-2442
Mailing Address - Country:US
Mailing Address - Phone:843-277-6779
Mailing Address - Fax:
Practice Address - Street 1:1001 PARIS AVE
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-2442
Practice Address - Country:US
Practice Address - Phone:843-277-6779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7121101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor