Provider Demographics
NPI:1801259627
Name:AHLVERS, AUDREY ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:ANNE
Last Name:AHLVERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 REGIONAL CIR
Mailing Address - Street 2:SUITE C
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9796
Mailing Address - Country:US
Mailing Address - Phone:910-255-1000
Mailing Address - Fax:910-255-1045
Practice Address - Street 1:5 REGIONAL CIR
Practice Address - Street 2:SUITE C
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9796
Practice Address - Country:US
Practice Address - Phone:910-255-1000
Practice Address - Fax:910-255-1045
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0099281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical