Individual
ETHAN LEE BEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LCAS-A
Contact information
Practice address
616 COLONNADE DR, CHARLOTTE, NC 28205-6827
(704) 273-3942
(704) 749-2305
Mailing address
284 EXECUTIVE PARK DR STE 100, CONCORD, NC 28025-1833
(704) 939-1100
(704) 939-1173
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCAS-29534
NC
Other
Enumeration date
11/06/2023
Last updated
11/06/2023
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