ETHAN LEE BEAVER

CHARLOTTE, NC
NPI1003689563
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: NC  LCAS-29534)
Enumeration Date2023-11-06
Last Update Date2023-11-06
Business Address
ETHAN LEE BEAVER MA, LCAS-A
616 COLONNADE DR
CHARLOTTE, NC 28205-6827
Phone number: 704-273-3942
Mailing Address
ETHAN LEE BEAVER MA, LCAS-A
284 EXECUTIVE PARK DR STE 100
CONCORD, NC 28025-1833
Phone number: 704-939-1100
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