Tavares Bostic, LCSW
Individual provider Active NPI Clinical Social Worker · Whiteville, NC
NPI 1134545908 · NPPES record last updated Jun 23, 2016
Key facts
- NPI
- 1134545908
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- C010090 (NC)
- Practice address
- 102 W Main St
Suite a
Whiteville, NC 28472-4012 - Phone
- (910) 642-7463
- NPI assigned
- Mar 17, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12058 | SC | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pace Health Network, LLC | Current |
Accepting new patients | |
| Premier Counseling Group PLLC | Past |
Accepting new patients | |
| Bostic Counseling & Consulting | Clinical | Past |
Accepting new patients |
Locations
139 Mallard Ln
Rockingham, NC 28379
Phone (910) 875-0750
102 W Main St
Ste A
Whiteville, NC 28472
Phone (910) 642-7463
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | C010090 | NC | Yes |
Addresses
Primary practice location
102 W Main St
Suite a
Whiteville, NC 28472-4012
Mailing address
201 Stroman Rd
Marston, NC 28363-9501
Phone (585) 967-8396
Other providers in Whiteville, NC
- Grant Bishop
- Courtney Briann Blackledge
- Tonia Blackwell
- Viola Elizabeth Blackwell
- Bladen Healthcare LLC
- James E Boston
- Kayla Bowen
- Christian Boyd
- Breathe Ez, Inc
- Brighter Day Health LLC
All providers in Whiteville, NC · Clinical Social Worker in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 23, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.