Provider Demographics
NPI:1215365903
Name:BEVERLY, STEPHANIE BELLEFEUILLE (LCAS-A)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:BELLEFEUILLE
Last Name:BEVERLY
Suffix:
Gender:
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 MALLOY ST STE E
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4478
Mailing Address - Country:US
Mailing Address - Phone:919-778-5594
Mailing Address - Fax:
Practice Address - Street 1:208 MALLOY ST STE E
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4478
Practice Address - Country:US
Practice Address - Phone:919-778-5594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20848101YM0800X
NC28718101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health