Provider Demographics
NPI:1205550605
Name:AGNESS, BEVERLY LYNESE (QMHP-A)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:LYNESE
Last Name:AGNESS
Suffix:
Gender:F
Credentials:QMHP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8022 CLOVERTREE CT
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5382
Mailing Address - Country:US
Mailing Address - Phone:804-304-4778
Mailing Address - Fax:804-331-0150
Practice Address - Street 1:8022 CLOVERTREE CT
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5382
Practice Address - Country:US
Practice Address - Phone:804-304-4778
Practice Address - Fax:804-331-0150
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0732000405101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health