Provider Demographics
NPI:1003212846
Name:BOSTIAN, ERSILIA (LCPC)
Entity Type:Individual
Prefix:
First Name:ERSILIA
Middle Name:
Last Name:BOSTIAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:LIA
Other - Middle Name:
Other - Last Name:BOSTIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:50 W MONTGOMERY AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4216
Mailing Address - Country:US
Mailing Address - Phone:301-678-3385
Mailing Address - Fax:
Practice Address - Street 1:50 W MONTGOMERY AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4216
Practice Address - Country:US
Practice Address - Phone:301-678-3385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4857101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional