Provider Demographics
NPI:1629529961
Name:SIMS, BEVERLY JEAN (MSW, LCAS-A)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:JEAN
Last Name:SIMS
Suffix:
Gender:F
Credentials:MSW, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 KINGSLEY RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2025
Mailing Address - Country:US
Mailing Address - Phone:910-759-0485
Mailing Address - Fax:
Practice Address - Street 1:M.E. GREEN HOUSE, LLC
Practice Address - Street 2:139C PINEHURST AVE
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28367
Practice Address - Country:US
Practice Address - Phone:910-725-1246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)