Healthcare Provider Details

I. General information

NPI: 1861014797
Provider Name (Legal Business Name): SAVANNAH JANE NEVAREZ MS, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAVANNAH JANE MARINO MS, LCMHC-A

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 03/27/2022
Certification Date: 03/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 WESTGATE DR STE 303
DURHAM NC
27707-2534
US

IV. Provider business mailing address

3622 LYCKAN PKWY STE 4008
DURHAM NC
27707-2539
US

V. Phone/Fax

Practice location:
  • Phone: 919-213-0225
  • Fax:
Mailing address:
  • Phone: 919-213-0225
  • Fax: 919-869-1467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA14231
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14231
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: