Healthcare Provider Details

I. General information

NPI: 1932205473
Provider Name (Legal Business Name): BEVERLY EATON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 BRENTWOOD CENTER LN N
WILSON NC
27896-1710
US

IV. Provider business mailing address

PO BOX 7626
WILSON NC
27895-7626
US

V. Phone/Fax

Practice location:
  • Phone: 252-293-9966
  • Fax: 252-293-9967
Mailing address:
  • Phone: 252-293-9966
  • Fax: 252-293-9967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC003025
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0706F
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerNC HEALTH CHOICE
# 2
Identifier6002010
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 3
Identifier0706F
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerSTATE HEALTH PLAN
# 4
Identifier186590
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerMANAGED HEALTH NETWORK
# 5
Identifier22143300
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerMEGELLAN HEALTH
# 6
Identifier0706F
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBLUE CROSS/BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: