Individual
CHARLES BOSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SUDCC III
Contact information
Practice address
955 E THOMPSON BLVD, VENTURA, CA 93001-3008
(805) 641-9100
(805) 641-2040
Mailing address
955 E THOMPSON BLVD, VENTURA, CA 93001-3008
(805) 641-9100
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
00700
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922056415
—
NV
Enumeration date
04/14/2016
Last updated
06/03/2021
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