Individual
CAROLYN ELAINE BEVERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
716 FITZLEE ST, GLASGOW, VA 24555-2530
(540) 258-1098
Mailing address
716 FITZLEE ST, GLASGOW, VA 24555-2530
(540) 258-1098
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
2469-01-001
VA
Other
Enumeration date
11/17/2015
Last updated
11/17/2015
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