Provider Demographics
NPI:1528574506
Name:BOYD, CHRISTINA (LICDC, LSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:LICDC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4030
Mailing Address - Country:US
Mailing Address - Phone:740-876-8290
Mailing Address - Fax:740-529-1205
Practice Address - Street 1:729 6TH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4030
Practice Address - Country:US
Practice Address - Phone:740-876-8290
Practice Address - Fax:740-529-1205
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII161919101YA0400X
OHS.22082321041C0700X
NDLICDC.162295101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0265831Medicaid