Boston, Willa

Boston, Willa is an sole proprietor health care provider with primary practice located at 9757 Blue Ridge Dr , Blue Ridge GA 30513-4167. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Boston, Willa can be contacted via phone (706) 455-2490.

Contact Information

Primary practice address
9757 Blue Ridge Dr Blue Ridge GA 30513-4167
Phone: (706) 455-2490
Fax: (706) 946-6574
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X PSY003953 Georgia
Behavioral Health & Social Service Providers / Clinical 103TC0700X PSY003953 Georgia

Profile Details

NPI number 1700259553
LBN Legal business name Boston, Willa
Credentials PSYD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 2nd, 2015
Last updated Dec 20th, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700259553 NPPES
Georgia MEDICAID 003169841A

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