Provider Demographics
NPI:1083092878
Name:EVERSON, CICELY (MH, CFMP)
Entity Type:Individual
Prefix:MRS
First Name:CICELY
Middle Name:
Last Name:EVERSON
Suffix:
Gender:F
Credentials:MH, CFMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18199 BEAVER DAM RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4535
Mailing Address - Country:US
Mailing Address - Phone:302-344-1789
Mailing Address - Fax:
Practice Address - Street 1:109 CHESTERFIELD DR
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-1220
Practice Address - Country:US
Practice Address - Phone:302-275-6879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000000174H00000X
OR000000174H00000X
DE174H00000X
SC171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator