Provider Demographics
NPI:1104608678
Name:BOYD, PAMELA L
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:L
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2928 FOX GLOVE DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-7119
Mailing Address - Country:US
Mailing Address - Phone:804-677-0020
Mailing Address - Fax:
Practice Address - Street 1:2928 FOX GLOVE DR
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-7119
Practice Address - Country:US
Practice Address - Phone:804-677-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral