Provider Demographics
NPI:1275595399
Name:BOHABOY, WILLIAM R JR (LCAS-A)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:BOHABOY
Suffix:JR
Gender:M
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 CHATFIELD DR
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-9246
Mailing Address - Country:US
Mailing Address - Phone:336-880-4534
Mailing Address - Fax:336-621-7513
Practice Address - Street 1:5140 DUNSTAN RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-9565
Practice Address - Country:US
Practice Address - Phone:336-621-3381
Practice Address - Fax:336-621-7513
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20990101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty