Provider Demographics
NPI:1255565792
Name:KNOTT, BEVERLY M (CNS)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:M
Last Name:KNOTT
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6461 LA PETITE PL
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-3885
Mailing Address - Country:US
Mailing Address - Phone:703-968-5641
Mailing Address - Fax:
Practice Address - Street 1:6461 LA PETITE PL
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-3885
Practice Address - Country:US
Practice Address - Phone:703-968-5641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000875101YM0800X
VA0024181898363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health