Healthcare Provider Details

I. General information

NPI: 1649891748
Provider Name (Legal Business Name): CHARLOTTE BOSTIC LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 LEXINGTON AVE UNIT D
EAST LANSDOWNE PA
19050-2550
US

IV. Provider business mailing address

50 LEXINGTON AVE APT D
EAST LANSDOWNE PA
19050-2550
US

V. Phone/Fax

Practice location:
  • Phone: 267-257-6901
  • Fax:
Mailing address:
  • Phone: 267-257-6901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC018531
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: