Provider Demographics
NPI:1740583111
Name:MONTGOMERY, BEVERLY A (MA, CACP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MA, CACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MEDICAL CT
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4760
Mailing Address - Country:US
Mailing Address - Phone:803-774-4020
Mailing Address - Fax:803-774-4025
Practice Address - Street 1:2 MEDICAL CT
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4760
Practice Address - Country:US
Practice Address - Phone:803-774-4020
Practice Address - Fax:803-774-4025
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health