Provider Demographics
NPI:1073660213
Name:CARVER, JERRELL LAVON (BSW)
Entity Type:Individual
Prefix:
First Name:JERRELL
Middle Name:LAVON
Last Name:CARVER
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 2ND ST
Mailing Address - Street 2:
Mailing Address - City:AYDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28513-7202
Mailing Address - Country:US
Mailing Address - Phone:252-531-4188
Mailing Address - Fax:
Practice Address - Street 1:512 2ND ST
Practice Address - Street 2:
Practice Address - City:AYDEN
Practice Address - State:NC
Practice Address - Zip Code:28513-7202
Practice Address - Country:US
Practice Address - Phone:252-531-4188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health