Basic Information
Provider Information | |||||||||
NPI: | 1417450677 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BOYKIN | ||||||||
FirstName: | ARABY | ||||||||
MiddleName: | EMILY | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LPC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CLUBB | ||||||||
OtherFirstName: | ARABY | ||||||||
OtherMiddleName: | EMILY | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1536 | ||||||||
Address2: |   | ||||||||
City: | MORGANTON | ||||||||
State: | NC | ||||||||
PostalCode: | 286801536 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8284373000 | ||||||||
FaxNumber: | 8284374999 | ||||||||
Practice Location | |||||||||
Address1: | 617 S GREEN ST STE 102 | ||||||||
Address2: |   | ||||||||
City: | MORGANTON | ||||||||
State: | NC | ||||||||
PostalCode: | 286553693 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8284373000 | ||||||||
FaxNumber: | 8284134999 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/14/2018 | ||||||||
LastUpdateDate: | 02/11/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/11/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 13801 | NC | N |   | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 13801 | NC | Y |   | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
ID | Type | State | Issuer | Description | A13801 | 01 | NC | LICENSURE | OTHER |