Provider Demographics
NPI:1982473617
Name:BOYER, BRIA
Entity type:Individual
Prefix:
First Name:BRIA
Middle Name:
Last Name:BOYER
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 1:1150 BRAMPTON AVE APT 425
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0847
Mailing Address - Country:US
Mailing Address - Phone:678-542-9551
Mailing Address - Fax:
Practice Address - Street 1:1150 BRAMPTON AVE APT 425
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0847
Practice Address - Country:US
Practice Address - Phone:678-542-9551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-23-293802106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician