Provider Demographics
NPI:1720343825
Name:BEVERLY, CARROLL ANNETTE (CADC-M)
Entity Type:Individual
Prefix:MISS
First Name:CARROLL
Middle Name:ANNETTE
Last Name:BEVERLY
Suffix:
Gender:F
Credentials:CADC-M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-2129
Mailing Address - Country:US
Mailing Address - Phone:989-752-6799
Mailing Address - Fax:
Practice Address - Street 1:3190 HALLMARK CT
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2190
Practice Address - Country:US
Practice Address - Phone:989-790-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIB 164108067648101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)