Provider Demographics
NPI:1538205950
Name:BOZICK, CHRISTINE TRUITT (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:TRUITT
Last Name:BOZICK
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:BOUNDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1978
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1978
Mailing Address - Country:US
Mailing Address - Phone:410-749-1015
Mailing Address - Fax:410-749-0654
Practice Address - Street 1:12145 ELM ST
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-1358
Practice Address - Country:US
Practice Address - Phone:410-651-2204
Practice Address - Fax:410-651-0790
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid
MD119591300Medicaid
211862Medicare Oscar/Certification