Provider Demographics
NPI:1811300338
Name:BOSTICK, LAREACA NAONE (LCSW)
Entity type:Individual
Prefix:MS
First Name:LAREACA
Middle Name:NAONE
Last Name:BOSTICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LAREACA
Other - Middle Name:
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 WHEEHAW RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-7013
Mailing Address - Country:US
Mailing Address - Phone:478-973-8627
Mailing Address - Fax:
Practice Address - Street 1:123 WHEEHAW RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-7013
Practice Address - Country:US
Practice Address - Phone:478-973-8627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0089571041C0700X
246RM2200X, 246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical