Provider Demographics
NPI:1902326424
Name:EVERETT, KIARA MARIE (LCAS-A)
Entity Type:Individual
Prefix:
First Name:KIARA
Middle Name:MARIE
Last Name:EVERETT
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 E JACKSON BLVD BLDG B
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28339-9629
Mailing Address - Country:US
Mailing Address - Phone:910-897-2008
Mailing Address - Fax:
Practice Address - Street 1:596 E JACKSON BLVD BLDG B
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:NC
Practice Address - Zip Code:28339-9629
Practice Address - Country:US
Practice Address - Phone:910-897-2008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-23652101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)