1588091094 NPI number — ELIZABETH MISSEY BOYKIN MSW, LCSW

Table of content: ELIZABETH MISSEY BOYKIN MSW, LCSW (NPI 1588091094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588091094 NPI number — ELIZABETH MISSEY BOYKIN MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYKIN
Provider First Name:
ELIZABETH
Provider Middle Name:
MISSEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MISSEY
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
LORRAINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588091094
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 PERIMETER PARK DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MORRISVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27560-8442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-570-7708
Provider Business Mailing Address Fax Number:
919-570-5877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11200 GOVERNOR MANLY WAY
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27614-8599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-570-7708
Provider Business Practice Location Address Fax Number:
919-570-5877
Provider Enumeration Date:
09/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C009554 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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