Provider Demographics
NPI:1457583890
Name:BOYLAN, DARIN MICHAEL (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:DARIN
Middle Name:MICHAEL
Last Name:BOYLAN
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2582
Mailing Address - Country:US
Mailing Address - Phone:229-244-9688
Mailing Address - Fax:229-244-5354
Practice Address - Street 1:103 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2582
Practice Address - Country:US
Practice Address - Phone:229-244-9688
Practice Address - Fax:229-244-5354
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005659101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional