Provider Demographics
NPI:1528479805
Name:BOSTON, DIANNA LYNNE (BCABA)
Entity type:Individual
Prefix:MRS
First Name:DIANNA
Middle Name:LYNNE
Last Name:BOSTON
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 HOPEMAN LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-9281
Mailing Address - Country:US
Mailing Address - Phone:630-207-2154
Mailing Address - Fax:
Practice Address - Street 1:2102 HOPEMAN LN
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-9281
Practice Address - Country:US
Practice Address - Phone:630-207-2154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-12-4924103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst