1932205473 NPI number — BEVERLY EATON LCSW

Table of content: BEVERLY EATON LCSW (NPI 1932205473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932205473 NPI number — BEVERLY EATON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EATON
Provider First Name:
BEVERLY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932205473
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7626
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27895-7626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-293-9966
Provider Business Mailing Address Fax Number:
252-293-9967

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 BRENTWOOD CENTER LN N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27896-1710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-293-9966
Provider Business Practice Location Address Fax Number:
252-293-9967
Provider Enumeration Date:
09/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C003025 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0706F . This is a "NC HEALTH CHOICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6002010 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0706F . This is a "STATE HEALTH PLAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 186590 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 22143300 . This is a "MEGELLAN HEALTH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0706F . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".