Provider Demographics
NPI:1336963412
Name:BOSTANY, EVELYN ALEXANDRA (LMFTA)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:ALEXANDRA
Last Name:BOSTANY
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 FAIRVIEW RD STE 700
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-0085
Mailing Address - Country:US
Mailing Address - Phone:980-255-5335
Mailing Address - Fax:
Practice Address - Street 1:5950 FAIRVIEW RD STE 700
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-0085
Practice Address - Country:US
Practice Address - Phone:980-255-5335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10606A106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist