Provider Demographics
NPI:1083921324
Name:BOYD, CHYNETHIA (MBA, RAS)
Entity Type:Individual
Prefix:
First Name:CHYNETHIA
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:MBA, RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 E ALBERTONI ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-1539
Mailing Address - Country:US
Mailing Address - Phone:310-217-0616
Mailing Address - Fax:310-217-0545
Practice Address - Street 1:637 E ALBERTONI ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-1539
Practice Address - Country:US
Practice Address - Phone:310-217-0616
Practice Address - Fax:310-217-0545
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA197247Medicaid