Basic Information
| Provider Information | |||||||||
| NPI: | 1508272634 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOYD | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LAC, MAC, ADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEWBERRY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291083351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032765690 | ||||||||
| FaxNumber: | 8033212234 | ||||||||
| Practice Location | |||||||||
| Address1: | 1547 PARKWAY | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296464081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642297120 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2014 | ||||||||
| LastUpdateDate: | 07/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 3335 | 01 | SC | MEDICARE | OTHER | 421504 | 05 | SC | MEDICAID |