Healthcare Provider Details

I. General information

NPI: 1801259122
Provider Name (Legal Business Name): BEVERLY EVERETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 CREEKSHIRE WAY STE 100
WINSTON SALEM NC
27103-3059
US

IV. Provider business mailing address

1255 CREEKSHIRE WAY STE 251
WINSTON SALEM NC
27103-3061
US

V. Phone/Fax

Practice location:
  • Phone: 336-701-3111
  • Fax: 888-757-4153
Mailing address:
  • Phone: 336-701-3111
  • Fax: 888-757-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberS12057
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: