Provider Demographics
NPI:1154197309
Name:BOST, TONYA (BS, QP)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:BOST
Suffix:
Gender:F
Credentials:BS, QP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 HOLLY GLEN DR APT G
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-8872
Mailing Address - Country:US
Mailing Address - Phone:757-637-8900
Mailing Address - Fax:
Practice Address - Street 1:2902 N HERRITAGE ST STE A
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1580
Practice Address - Country:US
Practice Address - Phone:252-686-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health