Healthcare Provider Details

I. General information

NPI: 1578905428
Provider Name (Legal Business Name): AKEANA N. C. BOYD-DOUGLAS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2013
Last Update Date: 07/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 S CHAPEL ST
NEWARK DE
19713-3467
US

IV. Provider business mailing address

8 LAKE TAHOE CIR
BEAR DE
19701-3801
US

V. Phone/Fax

Practice location:
  • Phone: 302-224-1400
  • Fax:
Mailing address:
  • Phone: 216-288-7988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberB1-0000726
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberB1-0000726
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberB1-0000726
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberB1-0000726
License Number StateDE
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberB1-0000726
License Number StateDE
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberB1-0000726
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: