Provider Demographics
NPI:1942392451
Name:BOATWRIGHT, BEN A (LPC)
Entity Type:Individual
Prefix:MR
First Name:BEN
Middle Name:A
Last Name:BOATWRIGHT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 REYNOLDS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2649
Mailing Address - Country:US
Mailing Address - Phone:803-237-6998
Mailing Address - Fax:
Practice Address - Street 1:2016 ASSEMBLY ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2142
Practice Address - Country:US
Practice Address - Phone:803-237-6997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4758101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor