Provider Demographics
NPI:1033383286
Name:BOSWELL, MARKIETA JOYCE (MA, LPC)
Entity Type:Individual
Prefix:MISS
First Name:MARKIETA
Middle Name:JOYCE
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8742 CUMBRIA CT
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-7164
Mailing Address - Country:US
Mailing Address - Phone:248-210-8380
Mailing Address - Fax:
Practice Address - Street 1:36185 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48335-3044
Practice Address - Country:US
Practice Address - Phone:248-778-7573
Practice Address - Fax:248-991-9533
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401019588101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional