Provider Demographics
NPI:1356665004
Name:EVERLINE, BETTY JOANNE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:JOANNE
Last Name:EVERLINE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:JOANNE
Other - Last Name:BRAINERD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:168 S HOWELL ST
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-2040
Mailing Address - Country:US
Mailing Address - Phone:517-437-5363
Mailing Address - Fax:
Practice Address - Street 1:168 S HOWELL ST
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-2040
Practice Address - Country:US
Practice Address - Phone:517-437-5363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010861151041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical