# INTEGRATED PRIMARY CARE AND BEHAVIORAL HEALTH SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588055685
- **Authorized official:** DR. TAWANDA BOSTIC DNP,PMHNP-BC, FNP-BC (OWNER)
- **Authorized official phone:** (704) 322-4699

## Contact information

- **Practice address:** 6201 FAIRVIEW RD, SUITE 200, CHARLOTTE, NC 28210-3289
- **Practice address phone:** (704) 322-4699
- **Practice address fax:** (704) 992-9546
- **Mailing address:** 6201 FAIRVIEW RD, SUITE 200, CHARLOTTE, NC 28210-3289
- **Mailing address phone:** (704) 322-4699
- **Mailing address fax:** (704) 992-9546

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LF0000X | Family Nurse Practitioner | 196483 | NC | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 196483 | NC | Yes |

## Other

- **Enumeration date:** 02/10/2015
- **Last updated:** 03/30/2015