Provider Demographics
NPI:1700802287
Name:PRINCE, BEVERLY DORIS (LPCS)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:DORIS
Last Name:PRINCE
Suffix:
Gender:F
Credentials:LPCS
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:DORIS
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:810 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-4306
Mailing Address - Country:US
Mailing Address - Phone:843-545-9135
Mailing Address - Fax:
Practice Address - Street 1:164 WACCAMAW MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8903
Practice Address - Country:US
Practice Address - Phone:843-347-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional