Provider Demographics
NPI:1285921551
Name:WEAVER, CARLENE EVETT (LPC)
Entity type:Individual
Prefix:MS
First Name:CARLENE
Middle Name:EVETT
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CARLENE
Other - Middle Name:EVETT
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:4246 FLAT ROCK CV
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-7993
Mailing Address - Country:US
Mailing Address - Phone:254-698-6607
Mailing Address - Fax:254-698-6607
Practice Address - Street 1:4246 FLAT ROCK CV
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-7993
Practice Address - Country:US
Practice Address - Phone:254-698-6607
Practice Address - Fax:254-698-6607
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67985101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional