Provider Demographics
NPI:1255737987
Name:EVERSOLE, AMBER JEAN (LPC)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:JEAN
Last Name:EVERSOLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5506 WHITTIER LN
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-0988
Mailing Address - Country:US
Mailing Address - Phone:704-438-7394
Mailing Address - Fax:
Practice Address - Street 1:1200 ELM ST STE A
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-1592
Practice Address - Country:US
Practice Address - Phone:704-438-7394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005730101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional