Individual
MRS. SHAVONDA LATIEA BEAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPA
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2477
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046KT
BCBS
NC
01
—
2118431
CIGNA
NC
05
—
6107067
—
NC
01
—
E4167-B0775
MEDCOST
NC
Enumeration date
10/27/2005
Last updated
04/25/2013
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