Provider Demographics
NPI:1992566954
Name:BOYETT, AMANDA E
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:E
Last Name:BOYETT
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 1:1930 CLUB POND RD UNIT 2009
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-8691
Mailing Address - Country:US
Mailing Address - Phone:919-444-0587
Mailing Address - Fax:
Practice Address - Street 1:1930 CLUB POND RD UNIT 2009
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-8691
Practice Address - Country:US
Practice Address - Phone:919-444-0587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty