Boutwell, Dia

Boutwell, Dia is an sole proprietor health care provider with primary practice located at 125 Howard Ln Ste B , Fayetteville GA 30215-1853. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Boutwell, Dia can be contacted via phone (502) 867-4851.

Contact Information

Primary practice address
125 Howard Ln Ste B Fayetteville GA 30215-1853
Phone: (502) 867-4851
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X PSY004367 Georgia

Profile Details

NPI number 1740757731
LBN Legal business name Boutwell, Dia
Credentials PHD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 27th, 2018
Last updated Feb 21st, 2020 - about 5 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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