Provider Demographics
NPI:1376645192
Name:BOYD, JOHN D (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:BOYD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 ARLINGTON BLVD
Mailing Address - Street 2:STE 209
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903
Mailing Address - Country:US
Mailing Address - Phone:434-972-1508
Mailing Address - Fax:434-972-1508
Practice Address - Street 1:1924 ARLINGTON BLVD
Practice Address - Street 2:STE 209
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903
Practice Address - Country:US
Practice Address - Phone:434-972-1508
Practice Address - Fax:434-972-1508
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000840103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical