Mary Eden Avery, LCSWA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P016252 Issued in NC

Practice address

4005 Oleander Dr
Wilmington, NC 28403-6816

Phone

(910) 790-9949

Fax

(910) 202-9966

NPI assigned

May 12, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624320000000",
    "number": "1053995373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 SHIPYARD BLVD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284126431",
            "telephone_number": "910-343-0145",
            "fax_number": "910-202-9966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4005 OLEANDER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036816",
            "telephone_number": "910-790-9949",
            "fax_number": "910-202-9966"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "615 Shipyard Blvd",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284126431",
            "country_code": "US",
            "telephone_number": "910-399-3755",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AVERY",
        "first_name": "MARY",
        "middle_name": "EDEN",
        "name_prefix": "Ms.",
        "credential": "LCSWA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-12",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P016252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ave Maria Family Practice, PLLC
• Jacob Averill, LCSW, LCAS, CCS
• Virginia Averitt, LPCA
• Danielle Marie Avery, RN/IBCLC
• Jennifer Avery, LCMHC
• Mary Catherine Avey
• Avid Health at Home North Carolina
• Awakening Wellness Professional Corporation
• Axis Prosthetics and Orthotics, Inc
• Lacey Ann Aycock, FNP-C

• Clinical Social Worker in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.