Provider Demographics
NPI:1396475695
Name:WEAVER, BARBARA SELL (LCMHC)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:SELL
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3568 SUMMERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4267
Mailing Address - Country:US
Mailing Address - Phone:336-972-1233
Mailing Address - Fax:
Practice Address - Street 1:3568 SUMMERFIELD LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4267
Practice Address - Country:US
Practice Address - Phone:336-972-1233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17586101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty