Provider Demographics
NPI:1407608268
Name:BOYD, LATISHIA DONIQUE
Entity Type:Individual
Prefix:
First Name:LATISHIA
Middle Name:DONIQUE
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 GREENBRIER DR APT 204
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5552
Mailing Address - Country:US
Mailing Address - Phone:826-200-0298
Mailing Address - Fax:
Practice Address - Street 1:620 GREENBRIER DR APT 204
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5552
Practice Address - Country:US
Practice Address - Phone:826-200-0298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician