Healthcare Provider Details

I. General information

NPI: 1316951981
Provider Name (Legal Business Name): STEPHANIE B BOYD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HARBISON WAY SUITE 229
COLUMBIA SC
29212-3422
US

IV. Provider business mailing address

1 HARBISON WAY SUITE 229
COLUMBIA SC
29212-3422
US

V. Phone/Fax

Practice location:
  • Phone: 803-749-6620
  • Fax: 803-407-6905
Mailing address:
  • Phone: 803-749-6620
  • Fax: 803-407-6905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberSC809
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: