Individual
WILLA BOSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
9757 BLUE RIDGE DR, BLUE RIDGE, GA 30513-4167
(706) 455-2490
(706) 946-6574
Mailing address
9757 BLUE RIDGE DR, BLUE RIDGE, GA 30513-4167
(706) 455-2490
(706) 946-6574
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PSY003953
GA
103TC0700X
Clinical Psychologist
Primary
PSY003953
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003169841A
—
GA
Enumeration date
11/02/2015
Last updated
12/20/2015
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