Provider Demographics
NPI:1316951981
Name:BOYD, STEPHANIE B (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:B
Last Name:BOYD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HARBISON WAY
Mailing Address - Street 2:SUITE 229
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-3422
Mailing Address - Country:US
Mailing Address - Phone:803-749-6620
Mailing Address - Fax:803-407-6905
Practice Address - Street 1:1 HARBISON WAY
Practice Address - Street 2:SUITE 229
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-3422
Practice Address - Country:US
Practice Address - Phone:803-749-6620
Practice Address - Fax:803-407-6905
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC809103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4410Medicaid
SCPS0336Medicaid
SCGP4395Medicaid