Provider Demographics
NPI:1568053577
Name:BOYD, REBECCA MARIE (MA, CAS, NCSP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:MARIE
Last Name:BOYD
Suffix:
Gender:F
Credentials:MA, CAS, NCSP
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:MARIE
Other - Last Name:O'HEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:213 BRENTWOOD CRES
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-2248
Mailing Address - Country:US
Mailing Address - Phone:302-519-0401
Mailing Address - Fax:
Practice Address - Street 1:641 CARRIAGE HILL RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-6518
Practice Address - Country:US
Practice Address - Phone:757-263-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0813001131103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool