Healthcare Provider Details

I. General information

NPI: 1396351953
Provider Name (Legal Business Name): DENNIS AUSTIN EVERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 COMMONS BLVD # C
PIEDMONT SC
29673-7766
US

IV. Provider business mailing address

1605 PINECROFT DR
TAYLORS SC
29687-2238
US

V. Phone/Fax

Practice location:
  • Phone: 864-520-8152
  • Fax:
Mailing address:
  • Phone: 864-616-4177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: