Provider Demographics
NPI:1609366954
Name:BOSTIAN, DYANA MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DYANA
Middle Name:MARIE
Last Name:BOSTIAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 MAGNOLIA CROSSING CIR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-6015
Mailing Address - Country:US
Mailing Address - Phone:704-449-2590
Mailing Address - Fax:
Practice Address - Street 1:646 MAGNOLIA CROSSING CIR NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-6015
Practice Address - Country:US
Practice Address - Phone:704-449-2590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-12
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0112931041C0700X
NCC0121531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical