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1003689563
ETHAN LEE BEAVER
CHARLOTTE, NC
NPI
1003689563
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: NC LCAS-29534)
Enumeration Date
2023-11-06
Last Update Date
2023-11-06
Business Address
ETHAN LEE BEAVER MA, LCAS-A
616 COLONNADE DR
CHARLOTTE, NC 28205-6827
Phone number: 704-273-3942
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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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