Provider Demographics
NPI:1912191610
Name:BOYD, CHARLENE CLARK (EDS)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:CLARK
Last Name:BOYD
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1965 QUAIL RIDGE RD APT G
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-0904
Mailing Address - Country:US
Mailing Address - Phone:252-355-5749
Mailing Address - Fax:
Practice Address - Street 1:1965 QUAIL RIDGE RD APT G
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-0904
Practice Address - Country:US
Practice Address - Phone:252-355-5749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3266101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor