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General NPI Number Information
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NPI Number | 1821581505
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Entity Type | Individual
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Provider Name | DENISHA EBONY BOYD CDCA167396
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Gender | Female
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Dates
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Enumeration Date | 06/07/2018
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Last Update Date | 06/07/2018
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Provider Practice Location Address
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Address Line | 43 E BABBITT ST
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City | DAYTON
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State | OH
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Zip | 45405-4903
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Country | US
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Telephone | 937-253-1680
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Fax |
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Provider Business Mailing Address
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Address Line | 2931 E 2ND ST
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City | DAYTON
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State | OH
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Zip | 45403-1266
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Country | US
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Telephone | 937-260-6365
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA167396
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License Number State | OH
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