Organization
DERIC J. BOSTON, LCSW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DERIC BOSTON LCSW (OWNER)
(919) 619-1032
Entity
Organization
Contact information
Practice address
1058 W CLUB BLVD, BOX 642, DURHAM, NC 27701-1104
(919) 619-1032
Mailing address
1058 W CLUB BLVD, STE 615, DURHAM, NC 27701-1104
(919) 619-1032
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
C006078
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
610643
—
NC
Enumeration date
07/11/2008
Last updated
05/21/2012
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