Provider Demographics
NPI:1821135765
Name:BOYD, MICHELLE MUSTIAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MUSTIAN
Last Name:BOYD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 802
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-0802
Mailing Address - Country:US
Mailing Address - Phone:252-332-7712
Mailing Address - Fax:
Practice Address - Street 1:220 BAKER ST W
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-2212
Practice Address - Country:US
Practice Address - Phone:252-332-7712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0034691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003550Medicaid
NC2871541Medicare ID - Type Unspecified