1457605743 NPI number — MS. CESSEL JEWON BOYD MA, LCMHC, LPC

Table of content: MS. CESSEL JEWON BOYD MA, LCMHC, LPC (NPI 1457605743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457605743 NPI number — MS. CESSEL JEWON BOYD MA, LCMHC, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYD
Provider First Name:
CESSEL
Provider Middle Name:
JEWON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LCMHC, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457605743
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
831 MACON EMBRO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27551-9276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-698-9972
Provider Business Mailing Address Fax Number:
888-320-9178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
136 S MAIN ST STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARRENTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27589-1967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-320-7119
Provider Business Practice Location Address Fax Number:
888-320-9178
Provider Enumeration Date:
11/08/2012

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: 101YM0800X , with the licence number:  9324 , 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)





Copyright © 2007-2025 www.npivalidator.com