Provider Demographics
NPI:1043728850
Name:BOSSONG, HEATHER MICHELLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MICHELLE
Last Name:BOSSONG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-0012
Mailing Address - Country:US
Mailing Address - Phone:678-367-5989
Mailing Address - Fax:
Practice Address - Street 1:41 CLAYTON ST STE 201
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2423
Practice Address - Country:US
Practice Address - Phone:954-667-7097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-15
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10068103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist