Most Relevant Information
Provider Data
| NPI Number: | 1003689563 |
| Provider Name: | ETHAN LEE BEAVER MA, LCAS-A |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | LCAS-29534 |
Most Important Dates
| Enumeration Date: | 11/06/2023 |
| Last Updated: | 11/06/2023 |
Provider Practice Location
616 COLONNADE DR
CHARLOTTE
NC
282056827
Practice Location Phone/Fax
| Phone: | 7042733942 |
| Fax: | 7047492305 |
Provider Mailing Location
284 EXECUTIVE PARK DR STE 100
CONCORD
NC
280251833
Provider Mailing Phone/Fax
| Phone: | 7049391100 |
| Fax: | 7049391173 |