Provider Demographics
NPI:1932211463
Name:BOYD, SHIRLEY
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:
Last Name:BOYD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E MAIN ST
Mailing Address - Street 2:STE 300
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-4541
Mailing Address - Country:US
Mailing Address - Phone:803-328-9600
Mailing Address - Fax:803-329-7141
Practice Address - Street 1:166 DOTSON ST
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2334
Practice Address - Country:US
Practice Address - Phone:803-327-2012
Practice Address - Fax:803-327-4198
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical