Provider Demographics
NPI:1790952901
Name:BOST, NOEL SEBASTIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:SEBASTIAN
Last Name:BOST
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 FOX GROVE TRL
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-9375
Mailing Address - Country:US
Mailing Address - Phone:336-674-2143
Mailing Address - Fax:
Practice Address - Street 1:3610 N ELM ST STE A
Practice Address - Street 2:SUITE 4
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2698
Practice Address - Country:US
Practice Address - Phone:336-674-9781
Practice Address - Fax:336-282-3430
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC006014101Y00000X, 101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904009132OtherLCSW LICENSE NUMBER
NCC006014OtherLCSW