| Doctor Name: | MR. TAVARES BOSTIC |
| NPI Number: | 1134545908 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSWA |
| License Number: | P008668 |
| Business Practice Address: | 630 S Madison St Whiteville, NC - 284724130 |
| Business Phone Number: | 9106427463 |
| Business Fax Number: | |
| Mailing Address: | 201 Stroman Rd, MARSTON |
| State: | NC |
| Postal Code: | 283639501 |
| Phone Number: | 5859678396 |
| Fax Number: | |
| NPI Enumeration Date: | 03/17/2014 |
| NPI Last Update Date: | 03/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | P008668 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |