Provider Demographics
NPI:1366567216
Name:BEVINS, LISA ANN (LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:BEVINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6600
Mailing Address - Country:US
Mailing Address - Phone:910-798-6587
Mailing Address - Fax:910-798-6643
Practice Address - Street 1:613 ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6803
Practice Address - Country:US
Practice Address - Phone:910-815-6948
Practice Address - Fax:910-772-7805
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC-4405101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102643Medicaid
NC136A4OtherBCBS