Provider Demographics
NPI:1568049195
Name:BOULWARE, FRAN LEVONNE (LGPC)
Entity Type:Individual
Prefix:
First Name:FRAN
Middle Name:LEVONNE
Last Name:BOULWARE
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 SNETTERTON LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8096
Mailing Address - Country:US
Mailing Address - Phone:301-448-9187
Mailing Address - Fax:
Practice Address - Street 1:2213 SNETTERTON LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8096
Practice Address - Country:US
Practice Address - Phone:301-448-9187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC00537101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional