Individual
WONDA BULLOCK BEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NCC, LCAS, LPC-A
Contact information
Practice address
9 DUCK POND CT, DURHAM, NC 27703-6096
(919) 451-2480
Mailing address
9 DUCK POND CT, PO BOX 11011, DURHAM, NC 27703-6096
(919) 451-2480
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
07/10/2012
Last updated
07/10/2012
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