Healthcare Provider Details

I. General information

NPI: 1902326424
Provider Name (Legal Business Name): KIARA MARIE EVERETT LCAS-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

596 E JACKSON BLVD BLDG B
ERWIN NC
28339-9629
US

IV. Provider business mailing address

596 E JACKSON BLVD BLDG B
ERWIN NC
28339-9629
US

V. Phone/Fax

Practice location:
  • Phone: 910-897-2008
  • Fax:
Mailing address:
  • Phone: 910-897-2008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-23652
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: