Provider Demographics
NPI:1598962227
Name:BOYD, DEBRA TAKEETA (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:TAKEETA
Last Name:BOYD
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17304 AUTUMN HARVEST CT
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2954
Mailing Address - Country:US
Mailing Address - Phone:301-916-2535
Mailing Address - Fax:301-916-2535
Practice Address - Street 1:20 CROSSROADS DR STE 104
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5480
Practice Address - Country:US
Practice Address - Phone:410-363-6770
Practice Address - Fax:410-363-9262
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD084311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical