=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780964759
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEAVER SLOAN CHRISTIAN AND MENTAL HEALTH COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2011
-----------------------------------------------------
Last Update Date | 08/23/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5277 PRINCESS ANNE RD
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23462-6398
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-613-2914
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 56288
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23456-9288
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-613-2914
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | EVA SLOAN
-----------------------------------------------------
Credential | L.C.S.W.
-----------------------------------------------------
Telephone | 757-613-2914
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904003303
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------