Provider Demographics
NPI:1154169761
Name:BOYNTON, MADISON (LPC-A)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:BOYNTON
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 PELHAM RD STE 107
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4182
Mailing Address - Country:US
Mailing Address - Phone:847-863-5826
Mailing Address - Fax:
Practice Address - Street 1:3519 PELHAM RD STE 107
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4182
Practice Address - Country:US
Practice Address - Phone:847-863-5826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9119101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health