Healthcare Provider Details

I. General information

NPI: 1003426917
Provider Name (Legal Business Name): CARESSE BOYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7031 CORPORATE WAY STE 103
DAYTON OH
45459-4262
US

IV. Provider business mailing address

7031 CORPORATE WAY STE 103
DAYTON OH
45459-4262
US

V. Phone/Fax

Practice location:
  • Phone: 937-619-9089
  • Fax: 937-265-6028
Mailing address:
  • Phone: 937-619-9089
  • Fax: 937-265-6028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number140757
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2512586
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: