Basic Information
| Provider Information | |||||||||
| NPI: | 1952339004 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EVERS | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA,LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2750 SPEISSEGGER DR | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294058701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437455153 | ||||||||
| FaxNumber: | 8437455142 | ||||||||
| Practice Location | |||||||||
| Address1: | 2750 SPEISSEGGER DR | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294058701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437455153 | ||||||||
| FaxNumber: | 8437455142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 3504 | SC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | HO MODIFIER | 05 | SC | MEDICAID |