Provider Demographics
NPI:1245803436
Name:DELOSSANTOS, BOYANA
Entity Type:Individual
Prefix:
First Name:BOYANA
Middle Name:
Last Name:DELOSSANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 BATTLEGROUND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2107
Mailing Address - Country:US
Mailing Address - Phone:336-337-5469
Mailing Address - Fax:336-660-2563
Practice Address - Street 1:901 BATTLEGROUND AVE STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2107
Practice Address - Country:US
Practice Address - Phone:336-337-5469
Practice Address - Fax:336-660-2563
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0166491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical