Provider Demographics
NPI:1083436018
Name:BOOKER, BEVERLY DYSHANNE (LCMHA)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:DYSHANNE
Last Name:BOOKER
Suffix:
Gender:F
Credentials:LCMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 GLENDARE CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-4735
Mailing Address - Country:US
Mailing Address - Phone:336-745-6732
Mailing Address - Fax:
Practice Address - Street 1:3333 BROOKVIEW HILLS BLVD STE 205
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5661
Practice Address - Country:US
Practice Address - Phone:336-261-6440
Practice Address - Fax:336-232-1436
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20095101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional