IndividualActive
Carolyn Beverly
NPI 1356715197 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Glasgow, VA
Provider details
- NPI number
- 1356715197
- Entity type
- Individual
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Sex
- Female
- Sole proprietor
- Yes
- License
- 2469-01-001 (VA)
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000XLicense 2469-01-001 (VA)
Residential Treatment Facilities
Practice location
716 Fitzlee St
Glasgow, VA 24555-2530
Phone: (540) 258-1098
Approximate (ZIP-level) locationGet directions
Mailing address
716 Fitzlee St
Glasgow, VA 24555-2530
Registry dates
- Enumerated
- 2015-11-17
- Last updated
- 2015-11-17
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.