Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 1410 | NC |
Y | 103G00000X | Clinical Psychologist | 1410 | NC |
Y | 103TC0700X | Clinical Psychologist | 1410 | NC |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 1410 | NC |
N | 103TH0004X | Health Psychologist | 1410 | NC |
N | 103TM1800X | Intellectual & Developmental Disabilities | 1410 | NC |
NPI | 1447469804 |
---|---|
Provider Name | Dr. Mary Lee Evers |
First Address | Roanoke Rapids, NC 27870-0640 |
Second Address | Roanoke Rapids, NC 27870-9436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 07/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0345A | NC BCBS (01) | NC |