Provider Demographics
NPI:1649640046
Name:EVERETTE, ISAAC (LCMHC, CADC)
Entity type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:
Last Name:EVERETTE
Suffix:
Gender:M
Credentials:LCMHC, CADC
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 7345
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27895-7345
Mailing Address - Country:US
Mailing Address - Phone:919-709-1518
Mailing Address - Fax:
Practice Address - Street 1:615 NASH ST E
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-6364
Practice Address - Country:US
Practice Address - Phone:252-292-6524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-29
Last Update Date:2024-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCADC-2824101YA0400X
NCQS141728101YP2500X
NC14587101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)