Provider Demographics
NPI:1891014874
Name:CERVERO, AUDREY (MA, LPC)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:CERVERO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 FAIRGROVE CHURCH RD SE STE 202
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-9289
Mailing Address - Country:US
Mailing Address - Phone:828-638-5907
Mailing Address - Fax:828-322-2280
Practice Address - Street 1:715 FAIRGROVE CHURCH RD SE STE 202
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-9289
Practice Address - Country:US
Practice Address - Phone:828-638-5907
Practice Address - Fax:828-322-2280
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-31
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7217101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1891014874Medicaid