Provider Demographics
NPI:1477792919
Name:TRIVETT-CLARK, EVA L (MA, LPA)
Entity Type:Individual
Prefix:MRS
First Name:EVA
Middle Name:L
Last Name:TRIVETT-CLARK
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 IVEY HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:NEWLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28657-9261
Mailing Address - Country:US
Mailing Address - Phone:828-260-4260
Mailing Address - Fax:
Practice Address - Street 1:436 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 235
Practice Address - City:LINVILLE
Practice Address - State:NC
Practice Address - Zip Code:28646
Practice Address - Country:US
Practice Address - Phone:828-737-7760
Practice Address - Fax:828-737-7606
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2277103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation