Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LC4857 | MD |
NPI | 1003212846 |
---|---|
Provider Name | Ersilia Bostian |
First Address | Rockville, MD 20850-4216 |
Second Address | Rockville, MD 20850-4216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2014 |
Last Update Date | 05/11/2014 |