Provider Demographics
NPI:1003025685
Name:PREVATT, BETTY-SHANNON (MA, LPA)
Entity Type:Individual
Prefix:MRS
First Name:BETTY-SHANNON
Middle Name:
Last Name:PREVATT
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MARSHFIELD PL
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-4972
Mailing Address - Country:US
Mailing Address - Phone:919-612-3348
Mailing Address - Fax:919-782-1399
Practice Address - Street 1:2601 LAKE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6688
Practice Address - Country:US
Practice Address - Phone:919-612-3348
Practice Address - Fax:919-782-1399
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2425103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical