Provider Demographics
NPI:1902505894
Name:BOYD, SUSAN A (MA:QMHP-A)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:BOYD
Suffix:
Gender:F
Credentials:MA:QMHP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 ROANOKE STATION RD
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:VA
Mailing Address - Zip Code:23964-3038
Mailing Address - Country:US
Mailing Address - Phone:434-262-5518
Mailing Address - Fax:
Practice Address - Street 1:1808 ROANOKE STATION RD
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:VA
Practice Address - Zip Code:23964-3038
Practice Address - Country:US
Practice Address - Phone:434-262-5518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA19340000X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health