Provider Demographics
NPI:1710052717
Name:BEARDEN, BEVERLY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:
Last Name:BEARDEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:BEVERLY
Other - Middle Name:
Other - Last Name:BEARDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:620 LYNNDALE CT STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5462
Mailing Address - Country:US
Mailing Address - Phone:252-756-3433
Mailing Address - Fax:252-756-7533
Practice Address - Street 1:620 LYNNDALE CT STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5462
Practice Address - Country:US
Practice Address - Phone:252-756-3433
Practice Address - Fax:252-756-7533
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4402101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE2338OtherMEDCOST