Provider Demographics
NPI:1821663477
Name:BOYD, EBONY (BS)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 GLENVIEW RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-1734
Mailing Address - Country:US
Mailing Address - Phone:804-651-0006
Mailing Address - Fax:
Practice Address - Street 1:1716 GLENVIEW RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-1734
Practice Address - Country:US
Practice Address - Phone:804-651-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2588101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health