Provider Demographics
NPI:1811109549
Name:ABBOTT, EYVETTE BROWN
Entity type:Individual
Prefix:MRS
First Name:EYVETTE
Middle Name:BROWN
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SOUTH MARSHALL STREET
Mailing Address - Street 2:STE. 221-22
Mailing Address - City:WS
Mailing Address - State:NC
Mailing Address - Zip Code:27101-5852
Mailing Address - Country:US
Mailing Address - Phone:336-473-9933
Mailing Address - Fax:
Practice Address - Street 1:1001 SOUTH MARSHALL STREET
Practice Address - Street 2:STE. 221-22
Practice Address - City:WS
Practice Address - State:NC
Practice Address - Zip Code:27101-5852
Practice Address - Country:US
Practice Address - Phone:336-473-9933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)