Provider Demographics
NPI:1598928632
Name:HOSTON, MICHAEL ANTHONY (ADDICTION THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:HOSTON
Suffix:
Gender:M
Credentials:ADDICTION THERAPIST
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:ANTHONY
Other - Last Name:HOSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAP
Mailing Address - Street 1:400 VETERANS AVE # T-106
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2410
Mailing Address - Country:US
Mailing Address - Phone:288-523-5902
Mailing Address - Fax:228-523-5955
Practice Address - Street 1:400 VETERANS AVE # T-106
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2410
Practice Address - Country:US
Practice Address - Phone:288-523-5902
Practice Address - Fax:228-523-5955
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2849101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)