Michael Antoine Boulware, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P018428 Issued in NC

Practice address

276 Old Mocksville Rd Ste 100
Statesville, NC 28625-1951

Phone

(704) 360-3637

Fax

(980) 939-8770

NPI assigned

Dec 19, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Integrative Wellness Solutions PLLCGroup PAC ID 8022341494, 143 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Integrative Wellness Solutions, PLLC

  • Psychologist
  • Mooresville, NC
  • NPI 1447760871
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1671408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777248000000",
    "number": "1619689825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "276 OLD MOCKSVILLE RD STE 100",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286251951",
            "telephone_number": "704-360-3637",
            "fax_number": "980-939-8770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "276 OLD MOCKSVILLE RD STE 100",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286251951",
            "telephone_number": "704-360-3637",
            "fax_number": "980-939-8770"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6637 Somersworth Dr",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282151840",
            "country_code": "US",
            "telephone_number": "704-666-3280",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOULWARE",
        "first_name": "MICHAEL",
        "middle_name": "ANTOINE",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-12-19",
        "last_updated": "2026-04-27",
        "certification_date": "2026-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P018428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kay J Bontrager, LPC
• Kelly Ann Boone, FNP
• Sarah G. Borders, LPC
• Michael Borja, MD
• Naim Ezzat Bouhussein, M.D.
• Shirley Anne Bowles, ED.D.
• Danita Bowling, J.D., PH.D.
• Janine Lynne Bowman, PHD
• Dianne Elliott Braddock, DA II
• Travis Matthew Bradey

• Clinical Social Worker in Statesville, NC
• Providers in Statesville, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.