Healthcare Provider Details

I. General information

NPI: 1366101388
Provider Name (Legal Business Name): CRYSTAL JERNEE EVERETTE BOYD LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5037 STONEWOOD PINES DR
KNIGHTDALE NC
27545-7544
US

IV. Provider business mailing address

3211 SHANNON RD STE 108
DURHAM NC
27707-6324
US

V. Phone/Fax

Practice location:
  • Phone: 252-578-3419
  • Fax:
Mailing address:
  • Phone: 919-665-8987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCMHC-17181
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: