Provider Demographics
NPI:1235392879
Name:ELVINGTON, JOSEPH BOYD JR (MA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BOYD
Last Name:ELVINGTON
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 EAST BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29709-5148
Mailing Address - Country:US
Mailing Address - Phone:843-623-7062
Mailing Address - Fax:843-623-7112
Practice Address - Street 1:1218 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:SC
Practice Address - Zip Code:29709-5148
Practice Address - Country:US
Practice Address - Phone:843-623-7062
Practice Address - Fax:843-623-7112
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC405127Medicaid
SC3343Medicare PIN