Organization
PSYCH AND SPOON
Active
Organization
PSYCH AND SPOON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAREACA BOSTICK LCSW (FOUNDER)
(478) 973-8627
Entity
Organization
Contact information
Practice address
123 WHEEHAW RD, MACON, GA 31211-7013
(478) 973-8627
Mailing address
123 WHEEHAW RD, MACON, GA 31211-7013
(478) 973-8627
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
133V00000X
Registered Dietitian
—
—
Other
Enumeration date
06/25/2026
Last updated
07/15/2026
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