Provider Demographics
NPI:1841201332
Name:BOYD, CLARENCE (LCSW)
Entity Type:Individual
Prefix:
First Name:CLARENCE
Middle Name:
Last Name:BOYD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2824 ESCONDIDO FARM ROAD
Mailing Address - Street 2:
Mailing Address - City:GARNE
Mailing Address - State:NC
Mailing Address - Zip Code:27529
Mailing Address - Country:US
Mailing Address - Phone:919-779-3979
Mailing Address - Fax:
Practice Address - Street 1:2824 ESCONDIDO FARM ROAD
Practice Address - Street 2:
Practice Address - City:GARNE
Practice Address - State:NC
Practice Address - Zip Code:27529
Practice Address - Country:US
Practice Address - Phone:919-779-3979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
C001756104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
17202OtherBCBS
NC2863915AMedicare PIN