Provider Demographics
NPI:1629269212
Name:BOCCIA, MARIA L (DMIN)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:L
Last Name:BOCCIA
Suffix:
Gender:F
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14406 WINGED TEAL RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7419
Mailing Address - Country:US
Mailing Address - Phone:704-299-2497
Mailing Address - Fax:
Practice Address - Street 1:14406 WINGED TEAL RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7419
Practice Address - Country:US
Practice Address - Phone:704-299-2497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5387101YP2500X
NC1168106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional