Provider Demographics
NPI:1184324667
Name:BOYD, ANGELA MARQUERITE (CSW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARQUERITE
Last Name:BOYD
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 PINE KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1364
Mailing Address - Country:US
Mailing Address - Phone:601-951-7841
Mailing Address - Fax:
Practice Address - Street 1:241 PINE KNOLL DR
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1364
Practice Address - Country:US
Practice Address - Phone:601-951-7841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW031051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical