Provider Demographics
NPI:1770676165
Name:BEVERLY, RONALD DEVIN (LPC,LSATP,CFAE)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:DEVIN
Last Name:BEVERLY
Suffix:
Gender:M
Credentials:LPC,LSATP,CFAE
Other - Prefix:MR
Other - First Name:R.
Other - Middle Name:DEVIN
Other - Last Name:BEVERLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC,LSATP,CFAE
Mailing Address - Street 1:21 WHETSTONE DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-1830
Mailing Address - Country:US
Mailing Address - Phone:757-825-6458
Mailing Address - Fax:
Practice Address - Street 1:2019 CUNNINGHAM DR
Practice Address - Street 2:SUITE 218
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3323
Practice Address - Country:US
Practice Address - Phone:757-262-1461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0812000438101Y00000X
VA0718000158101YA0400X
VA0701003321101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA437277Medicare UPIN
VAO81055MMedicare UPIN