Provider Demographics
NPI:1073729448
Name:LACAVERA, CHARLES JOSEPH (MS, CRC, CCS, LPCS)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:LACAVERA
Suffix:
Gender:M
Credentials:MS, CRC, CCS, LPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8485
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27835-8485
Mailing Address - Country:US
Mailing Address - Phone:252-327-1014
Mailing Address - Fax:252-695-0207
Practice Address - Street 1:401 W FIRST ST
Practice Address - Street 2:SUITE F
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-1905
Practice Address - Country:US
Practice Address - Phone:252-327-1014
Practice Address - Fax:252-695-0207
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2012-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS 1021101YA0400X
NCLPC 5318101YP2500X
NCCCS #459101YA0400X
NCLPCS #5318S101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)