Provider Demographics
NPI:1255962403
Name:BOYKIN, JACLYN NICOLE (LPC)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:NICOLE
Last Name:BOYKIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5403 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-6007
Mailing Address - Country:US
Mailing Address - Phone:804-204-9255
Mailing Address - Fax:
Practice Address - Street 1:5403 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-6007
Practice Address - Country:US
Practice Address - Phone:804-204-9255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701009581101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701009581OtherDEPARTMENT OF HEALTH PROFESSIONS