Healthcare Provider Details

I. General information

NPI: 1891007910
Provider Name (Legal Business Name): ALMA DEE BOSTICK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 W MILLBROOK RD
RALEIGH NC
27609-4304
US

IV. Provider business mailing address

12509 STONEMILL WAY
RALEIGH NC
27614-9617
US

V. Phone/Fax

Practice location:
  • Phone: 919-810-3167
  • Fax:
Mailing address:
  • Phone: 919-810-3167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4306150
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: