Provider Demographics
NPI:1154876118
Name:AVERITT, VIRGINIA (LPCA)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:AVERITT
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4809 ATLANTIS CT
Mailing Address - Street 2:APT. 7
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6422
Mailing Address - Country:US
Mailing Address - Phone:910-547-1760
Mailing Address - Fax:910-833-5905
Practice Address - Street 1:1136 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-6439
Practice Address - Country:US
Practice Address - Phone:910-833-5902
Practice Address - Fax:910-833-5905
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12263101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional