Doctor Name: | DALE BOSTWICK |
NPI Number: | 1184009334 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ED.S. |
License Number: | 0803000252 |
Business Practice Address: | 108 W Washington St Suite 204 Middleburg, VA - 20117 |
Business Phone Number: | 7039759713 |
Business Fax Number: | |
Mailing Address: | 43368 Wayfarer Sq, CHANTILLY |
State: | VA |
Postal Code: | 201522059 |
Phone Number: | 7039759713 |
Fax Number: | |
NPI Enumeration Date: | 07/29/2015 |
NPI Last Update Date: | 07/29/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | 0803000252 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |