Provider Demographics
NPI:1922347970
Name:EVERLY, ANDREW MARTIN (MS)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:MARTIN
Last Name:EVERLY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 MCCLELLAN RD
Mailing Address - Street 2:
Mailing Address - City:PHILIPPI
Mailing Address - State:WV
Mailing Address - Zip Code:26416-8076
Mailing Address - Country:US
Mailing Address - Phone:304-457-2800
Mailing Address - Fax:304-457-4011
Practice Address - Street 1:116 MCCLELLAN RD
Practice Address - Street 2:
Practice Address - City:PHILIPPI
Practice Address - State:WV
Practice Address - Zip Code:26416-8076
Practice Address - Country:US
Practice Address - Phone:304-457-2800
Practice Address - Fax:304-457-4011
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1068103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist