Provider Demographics
NPI:1285986653
Name:LITTLE, BEVERLY LUCILLE (LPCA)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:LUCILLE
Last Name:LITTLE
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 1:3701 ASHBROOK DR NW APT 1111
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-7626
Mailing Address - Country:US
Mailing Address - Phone:919-394-9745
Mailing Address - Fax:
Practice Address - Street 1:3701 ASHBROOK DR NW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-7620
Practice Address - Country:US
Practice Address - Phone:919-394-9745
Practice Address - Fax:919-739-4989
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9655101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA9655OtherNORTH CAROLINA BOARD OF LICENSED PROFESSIONAL COUNSELORS