Provider Demographics
NPI:1396336681
Name:BOYD-DIGGS, ANDRIA P
Entity type:Individual
Prefix:
First Name:ANDRIA
Middle Name:P
Last Name:BOYD-DIGGS
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 1:2808 ENTERPRISE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2753
Mailing Address - Country:US
Mailing Address - Phone:813-358-8475
Mailing Address - Fax:
Practice Address - Street 1:2808 ENTERPRISE RD STE 105
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2753
Practice Address - Country:US
Practice Address - Phone:813-358-8475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
FLIMT3839106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator