Provider Demographics
NPI:1194888750
Name:PEVERALL, TROY BRITTON (LPC, LCAS)
Entity type:Individual
Prefix:MR
First Name:TROY
Middle Name:BRITTON
Last Name:PEVERALL
Suffix:
Gender:M
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 WRIGHTSVILLE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4140
Mailing Address - Country:US
Mailing Address - Phone:910-251-7789
Mailing Address - Fax:910-399-6598
Practice Address - Street 1:3725 WRIGHTSVILLE AVENUE, STE B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4012
Practice Address - Country:US
Practice Address - Phone:910-251-7789
Practice Address - Fax:910-399-6598
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC681101YA0400X
NC4276101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)