MR. MICHAEL ANTOINE BOULWARE LCSW
NPI 1619689825
Social Worker - Clinical in Statesville, NC

Q: What is Michael Boulware's NPI number?

The NPI number for Michael Boulware is 1619689825. It was assigned to this individual provider in the NPPES registry on December 19, 2022.

Q: What is Michael Boulware's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Q: When was this NPI record last updated?

The NPPES record for Michael Boulware was last updated on April 27, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since December 19, 2022PECOS EnrolledAccepts Medicare Assignment

276 OLD MOCKSVILLE RD STE 100, STATESVILLE, NC 28625(704) 360-3637(980) 939-8770 Get Directions Write a Review

NPPES record last updated: April 27, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 27, 2026, Dec 19, 2022 (2 updates tracked since 2022).

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About Mr. Michael Antoine Boulware Lcsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. MICHAEL ANTOINE BOULWARE LCSW (NPI 1619689825) is an individual clinical provider in Statesville, North Carolina, licensed in North Carolina (P018428) and active in the NPI registry since December 2022. He is enrolled in Medicare PECOS, maintains a secondary practice location in Charlotte, and is a graduate of Other (2022).

NPPES Registry Identity

NPI1619689825

Entity TypeIndividualMale

Primary Taxonomy1041C0700X

Provider Legal NameMR. MICHAEL ANTOINE BOULWARECredential: LCSW

Location Address276 OLD MOCKSVILLE RD STE 100Statesville, NC 28625-1951

Mailing Address276 Old Mocksville Rd Ste 100Statesville, NC 28625-1951 · (704) 360-3637 · Fax (980) 939-8770

Phone(704) 360-3637

Fax(980) 939-8770

Sole ProprietorNo

Medical School CMSOtherGraduated 2022

Enumeration DateDecember 19, 2022

Last NPPES UpdateApril 27, 20262 updates tracked since enumeration

NPPES CertifiedApril 27, 2026

✔ NPI 1619689825 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code1041C0700X

License✔ Licensed in NC · P018428

Definition

A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

276 OLD MOCKSVILLE RD STE 100, Statesville, NC 28625

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Secondary Practice Location 1

Location 16637 Somersworth DrCharlotte, NC 28215-1840 · Phone (704) 666-3280

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mr. Michael Antoine Boulware Lcsw is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID244708493

PECOS Enrollment IDI20260506000385

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 28625 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$0.00 typical visit price

range $54.12 – $165.09

Typical copayment $0.00 (range $13.53 – $41.27)

Most-billed visit code NA

Established Patient

$67.72 typical visit price

range $17.21 – $134.61

Typical copayment $16.93 (range $4.30 – $33.65)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. SUE ANN BINGHAM BROWN MSW, LCSW, PIP

Social Worker (Clinical)