MEDICARE: BEVERLY CHISHOLM LCMHCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	S11369	NC

General Provider Information

NPI Number	:	1770976532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY CHISHOLM LCMHCS

Provider Business Mailing Address
First Line	:	105 INISFREE PL
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-7525
Country	:	US
Telephone Number	:	919-244-7638
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 INISFREE PL
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-7525
Country	:	US
Telephone Number	:	919-244-7638
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2015
Last Update Date	:	12/15/2025

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Directions to “ BEVERLY CHISHOLM LCMHCS” Practice Location

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