Provider Demographics
NPI:1285375667
Name:BOYETTE, LISA PURVIS (COUNSELOR)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:PURVIS
Last Name:BOYETTE
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 JIMMYS RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-9666
Mailing Address - Country:US
Mailing Address - Phone:252-349-3602
Mailing Address - Fax:
Practice Address - Street 1:2407 GRACE AVE STE 7
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-4417
Practice Address - Country:US
Practice Address - Phone:252-349-3602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17369101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health