Healthcare Provider Details

I. General information

NPI: 1144839978
Provider Name (Legal Business Name): ABIGAIL GLYNN BOYLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 10/09/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 COVIL AVE SUITE 102
WILMINGTON NC
28403
US

IV. Provider business mailing address

115 HILLSDALE DRIVE
WILMINGTON NC
28403
US

V. Phone/Fax

Practice location:
  • Phone: 888-392-8642
  • Fax:
Mailing address:
  • Phone: 910-224-3123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: