Provider Demographics
NPI:1689128969
Name:DE BOSTOCK, JOIE CHRISTINE
Entity Type:Individual
Prefix:MISS
First Name:JOIE
Middle Name:CHRISTINE
Last Name:DE BOSTOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JOY
Other - Middle Name:CHRISTINE
Other - Last Name:BOSTICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:529 MAIN ST # 206
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-2509
Mailing Address - Country:US
Mailing Address - Phone:513-400-3928
Mailing Address - Fax:
Practice Address - Street 1:529 MAIN ST # 206
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-2509
Practice Address - Country:US
Practice Address - Phone:786-755-1863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161935101YA0400X
ORC6623101YP2500X
ATCB.22.025221700000X
101YM0800X
OHE.2102397-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health