DERIC J. BOSTON, LCSW (NPI# 1891959524) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891959524 |
| Entity Type | Organization |
| Organization Name | DERIC J. BOSTON, LCSW |
| Practice Address |
1058 W Club Blvd Box 642 Durham NC 27701-1104 |
| Mailing Address |
1058 W Club Blvd Ste 615 Durham NC 27701-1104 |
| Practice Telephone | 9196191032 |
| Mailing Telephone | 9196191032 |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2012-05-21 |
| Authorized Official Name | DERIC BOSTON (OWNER) |
| Authorized Official Telephone | 9196191032 |
| Authorized Official Credential | LCSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | C006078 | NC | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 610643 | 05 |
| Street Address |
1058 W CLUB BLVD BOX 642 |
| City | DURHAM |
| State | NC |
| Zip Code | 27701-1104 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205819547 | Optometric Eye Care Center of Durham Pa | Technician/Technologist | 1058 W Club Blvd, Durham, NC 27701-1115 | 2005-11-21 |
| 1326572322 | Khr Beauty& Hairloss Center LLC | Specialist | 1058 W Club Blvd, 623, Durham, NC 27701-1104 | 2017-04-17 |
| 1982153581 | Keisha Hunterrorie | Specialist | 1058 W Club Blvd, 623, Durham, NC 27701-1104 | 2016-09-25 |
| 1811353451 | Ava V Hinton Pllc | Counselor | 1058 W Club Blvd, Ste 602, Durham, NC 27701-1104 | 2016-01-12 |
| 1073998928 | Emowellness Incorporated | Clinical Nurse Specialist | 1058 W Club Blvd, Suite 614, Durham, NC 27701-1104 | 2015-07-21 |
| 1891031464 | Ava Vernell Hinton | Counselor | 1058 W Club Blvd, Suite #614, Durham, NC 27701-1104 | 2012-12-29 |
| 1225381338 | Lei Ventures,llc | In Home Supportive Care | 1058 W Club Blvd, 220a, Durham, NC 27701-1104 | 2012-10-26 |
| 1629360748 | Hilda Lavette Williams | Social Worker | 1058 W Club Blvd, Ste 602, Durham, NC 27701-1159 | 2011-05-08 |
| 1841521911 | Randy Robinson | Counselor | 1058 W Club Blvd, Suite 616, Durham, NC 27701-1104 | 2010-01-28 |
| 1942495023 | Anna V Leggett | Optometrist | 1058 W Club Blvd, Durham, NC 27701-1104 | 2007-09-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952956179 | Sa'naa Lenoir | Naturopath | 1213 Avondale Drive Suite 4, Durham, NC 27701 | 2019-08-05 |
| 1225682792 | Sherifat Balogun | Pharmacist | 406 Rigsbee Ave Suite 201, Durham, NC 27701 | 2019-08-01 |
| 1427575950 | Kristen Kesler Desena | Speech-Language Pathologist | 1105 Englewood Avenue, Durham, NC 27701 | 2017-08-25 |
| 1295255263 | Tiffany Claire Ashe | Social Worker | 331 W Main St Ste 308, Durham, NC 27701 | 2017-06-21 |
| 1265815096 | Colleen Hamman | Specialist/Technologist | 616 E Lawson St, Durham, NC 27701 | 2015-06-29 |
| 1366843286 | Gene Mcphaul | Counselor | 3545 Mayfair St, Durham, NC 27701 | 2014-09-10 |
| 1245652957 | Michelle Annette Underdue | Social Worker | 801 East Main Street, Suite 2-120, Durham, NC 27701 | 2014-01-15 |
| 1518306109 | Lincicome Home | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 300-a Northwood Circle, Durham, NC 27701 | 2013-06-18 |
| 1669754693 | Ruffin Home 2 | Assisted Living Facility | 830 N. Mangum St., Durham, NC 27701 | 2011-09-15 |
| 1609192657 | Samaritan Health Center, Inc. | Clinic/Center | 507 E. Knox Street, Durham, NC 27701 | 2010-04-15 |
| Find all providers in zip 27701 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417578667 | Alternative Choice Home Care Agency, LLC | Community/Behavioral Health | 800 N Mangum St Ste A-i, Durham, NC 27701-2260 | 2020-04-29 |
| 1316589138 | Monarch | Community/Behavioral Health | 1513 Piperwood Court, Durham, NC 27713 | 2019-10-14 |
| 1457916132 | Kalvin Franklin Jr. | Community/Behavioral Health | 2632 Cherry Creek Dr, Durham, NC 27703-5746 | 2019-05-07 |
| 1356804108 | Komkare Empowerment Center | Community/Behavioral Health | 1058 W Club Blvd Ste 232, Durham, NC 27701-1149 | 2019-04-09 |
| 1952883431 | Willow Oak Therapy, Pllc | Community/Behavioral Health | 3622 Lyckan Pkwy Ste 6006, Durham, NC 27707-2539 | 2018-08-31 |
| 1033634886 | Liasions Community Care | Community/Behavioral Health | 304a N Driver St, Durham, NC 27703-3058 | 2017-08-12 |
| 1447785134 | Nathaniel David Sawyer | Community/Behavioral Health | 5731 N Roxboro Rd, Durham, NC 27712-1427 | 2017-05-01 |
| 1376075556 | Baart Community Healthcare | Community/Behavioral Health | 800 N Mangum St Ste 300&400, Durham, NC 27701-2260 | 2017-03-28 |
| 1457807968 | Therapeutic Interventions Pllc | Community/Behavioral Health | 1058 W Club Blvd Ste 602, Durham, NC 27701-1159 | 2016-08-25 |
| 1912355298 | Harmony Healthcare Services, LLC | Community/Behavioral Health | 4004 Ben Franklin Blvd Ste C, Durham, NC 27704-2384 | 2016-05-27 |
| Find all providers in DURHAM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.