Provider Demographics
NPI:1215060637
Name:BECKWITH, VELVET DENISE (LCAS)
Entity type:Individual
Prefix:MRS
First Name:VELVET
Middle Name:DENISE
Last Name:BECKWITH
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 RIDGEWAY DREWRY RD
Mailing Address - Street 2:PO BOX 286
Mailing Address - City:MANSON
Mailing Address - State:NC
Mailing Address - Zip Code:27553-9737
Mailing Address - Country:US
Mailing Address - Phone:252-456-4057
Mailing Address - Fax:
Practice Address - Street 1:721 TUCKER ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1248
Practice Address - Country:US
Practice Address - Phone:919-833-8862
Practice Address - Fax:919-833-8595
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1071101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111888Medicaid