Provider Demographics
NPI:1861014797
Name:NEVAREZ, SAVANNAH JANE (MS, LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:SAVANNAH
Middle Name:JANE
Last Name:NEVAREZ
Suffix:
Gender:F
Credentials:MS, LCMHC
Other - Prefix:MS
Other - First Name:SAVANNAH
Other - Middle Name:JANE
Other - Last Name:MARINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LCMHC-A
Mailing Address - Street 1:3622 LYCKAN PKWY STE 4008
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2539
Mailing Address - Country:US
Mailing Address - Phone:919-213-0225
Mailing Address - Fax:919-869-1467
Practice Address - Street 1:3500 WESTGATE DR STE 303
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2534
Practice Address - Country:US
Practice Address - Phone:919-213-0225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14231101YP2500X
NC14231101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty