Provider Demographics
NPI:1104372424
Name:BOSTIC COUNSELING & CONSULTING
Entity Type:Organization
Organization Name:BOSTIC COUNSELING & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAVARES
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSTIC
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:585-967-8396
Mailing Address - Street 1:207 CAROLYNS MILL PL
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-7986
Mailing Address - Country:US
Mailing Address - Phone:585-967-8396
Mailing Address - Fax:
Practice Address - Street 1:801 E BROAD AVE
Practice Address - Street 2:SUITE 18
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4382
Practice Address - Country:US
Practice Address - Phone:585-967-8396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0100901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty