Provider Demographics
NPI:1720378516
Name:MILKS, BEVERLY NICOLE (MS/EDS, NCC, LPC)
Entity Type:Individual
Prefix:MISS
First Name:BEVERLY
Middle Name:NICOLE
Last Name:MILKS
Suffix:
Gender:F
Credentials:MS/EDS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E 5TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-3095
Mailing Address - Country:US
Mailing Address - Phone:704-332-9034
Mailing Address - Fax:
Practice Address - Street 1:601 E 5TH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-3031
Practice Address - Country:US
Practice Address - Phone:704-332-9034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8623101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health