Basic Information
| Provider Information | |||||||||
| NPI: | 1235748153 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOYETTE | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | ANDREWS | ||||||||
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| Credential: | LCMHCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 859 ELI MOORE CT | ||||||||
| Address2: | |||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272653118 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4140 CHERRY ST | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271052536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662727826 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2020 | ||||||||
| LastUpdateDate: | 07/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A14909 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.