Individual provider · Type 1 NPI

Ethan Lee Beaver, MA, LCAS-A

Addiction (Substance Use Disorder) Counselor · Charlotte, NC

NPI number 1003689563 Active

Practice location

616 Colonnade Dr
Charlotte, NC 28205-6827

Call (704) 273-3942 Map

Fax (704) 749-2305

Mailing address

284 Executive Park Dr Ste 100
Concord, NC 28025-1833

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400XLCAS-29534 (NC)

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1003689563

Ethan Lee Beaver, MA, LCAS-A's National Provider Identifier is 1003689563, issued on Nov 6, 2023. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Charlotte, NC. The record was last updated on Nov 6, 2023.