Jeffrey Wayne Beaver Jr., LCSWA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P017309 Issued in NC

Practice address

615 Shipyard Blvd
Wilmington, NC 28412-6431

Phone

(910) 202-3155

Fax

(910) 202-5772

NPI assigned

Apr 5, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Thunder Therapy

  • Professional Counselor
  • Wilmington, NC
  • NPI 1720897424

  Clinical

  NPD Authorized official

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

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650931200000",
    "number": "1316688328",
    "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": "910-202-3155",
            "fax_number": "910-202-5772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 SHIPYARD BLVD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284126431",
            "telephone_number": "910-202-3155",
            "fax_number": "910-202-5772"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "309 Progress Dr",
            "address_purpose": "LOCATION",
            "city": "Burgaw",
            "state": "NC",
            "postal_code": "284253280",
            "country_code": "US",
            "telephone_number": "910-259-0668",
            "fax_number": "910-202-9966",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BEAVER",
        "first_name": "JEFFREY",
        "middle_name": "WAYNE",
        "name_suffix": "Jr.",
        "credential": "LCSWA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-05",
        "last_updated": "2022-04-26",
        "certification_date": "2022-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P017309",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922022607",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://coastalhorizons.org/",
            "affiliation": "N",
            "address_1": "615 Shipyard Blvd",
            "city": "Wilmington",
            "state": "NC",
            "country_code": "US",
            "postal_code": "284126431",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Latonya Rochelle Beatty, MD
• Eric Beaudet, DDS
• Jolene Marie Beaumont, AGPCNP
• Amy Bruce Beausang, PHARMD, CHHC
• Elizabeth Beaver
• Jonathan Beaver
• Gregory Gerard Bebb, MD
• Because Hearing Matters, PLLC
• Beverly Atwood Beck, M.ED, CCC-SLP, RN
• Daniel Turney Beck, O.D.

• 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 Apr 26, 2022; 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.