Provider Demographics
NPI:1932462066
Name:BEAVER, MELISSA ELAINE (CSAC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ELAINE
Last Name:BEAVER
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2352
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-2352
Mailing Address - Country:US
Mailing Address - Phone:828-855-9595
Mailing Address - Fax:828-855-9599
Practice Address - Street 1:323 2ND ST NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-4904
Practice Address - Country:US
Practice Address - Phone:828-855-9595
Practice Address - Fax:828-855-9599
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2183101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC453137563OtherTAX ID