Provider Demographics
NPI:1215367594
Name:CALLOWAY, BEVERLY (RN)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:
Last Name:CALLOWAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 FOREST CIR
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-2869
Mailing Address - Country:US
Mailing Address - Phone:843-549-1551
Mailing Address - Fax:
Practice Address - Street 1:507 FOREST CIR
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2869
Practice Address - Country:US
Practice Address - Phone:843-549-1551
Practice Address - Fax:843-549-5687
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50880101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC576000922OtherEIN