Provider Demographics
NPI:1265485437
Name:EVERHART, DANIEL ERIK (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ERIK
Last Name:EVERHART
Suffix:
Gender:M
Credentials:PHD
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 3301
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27836-1301
Mailing Address - Country:US
Mailing Address - Phone:252-756-7839
Mailing Address - Fax:252-756-7830
Practice Address - Street 1:219 COMMERCE ST
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5035
Practice Address - Country:US
Practice Address - Phone:252-758-7830
Practice Address - Fax:252-756-7830
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2646103G00000X, 103TC0700X, 103TH0100X
NY014309103G00000X, 103TC0700X
NC014309103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC045J9OtherBC/BS
NC184870OtherMEDCOST
NC6000200Medicaid
NC2819936Medicare ID - Type Unspecified