Provider Demographics
NPI:1053557637
Name:BOYD, LAVONDRA ALICIA
Entity type:Individual
Prefix:
First Name:LAVONDRA
Middle Name:ALICIA
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAVONDRA
Other - Middle Name:ALICIA
Other - Last Name:MCCLOUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2543 RAVENHILL DR STE B
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5459
Mailing Address - Country:US
Mailing Address - Phone:910-339-1928
Mailing Address - Fax:910-339-8450
Practice Address - Street 1:2543 RAVENHILL DR STE B
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303
Practice Address - Country:US
Practice Address - Phone:910-339-1928
Practice Address - Fax:910-339-8450
Is Sole Proprietor?:No
Enumeration Date:2009-01-02
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health