Healthcare Provider Details

I. General information

NPI: 1093650111
Provider Name (Legal Business Name): LKENYA BODDIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 FAYETTEVILLE ST STE 1100
RALEIGH NC
27601-3000
US

IV. Provider business mailing address

147 WINNERS CIR
CARY NC
27511-5363
US

V. Phone/Fax

Practice location:
  • Phone: 252-366-4284
  • Fax:
Mailing address:
  • Phone: 252-366-4284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: