Provider Demographics
NPI:1497249197
Name:AVILES RUIZ, EVERARDO (MSW, LCSW, LCAS)
Entity type:Individual
Prefix:MR
First Name:EVERARDO
Middle Name:
Last Name:AVILES RUIZ
Suffix:
Gender:M
Credentials:MSW, LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1981 WORSHAM MILL RD
Mailing Address - Street 2:
Mailing Address - City:RUFFIN
Mailing Address - State:NC
Mailing Address - Zip Code:27326-9421
Mailing Address - Country:US
Mailing Address - Phone:336-705-4774
Mailing Address - Fax:
Practice Address - Street 1:371 NC HIGHWAY 65 STE 204
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-8881
Practice Address - Country:US
Practice Address - Phone:336-342-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-24740101YA0400X
NCC0132861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical