Evergreen Therapeutic, PLLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

EVERGREEN THERAPEUTIC, PLLC

Practice address

7427 Old Stage Rd N
Angier, NC 27501-7401

Phone

(919) 561-9663

NPI assigned

Oct 26, 2020

Last updated

Oct 26, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Anna Bengtson Broadwell, MA, MDIV, LCMHCNPI 1295225373

Title

Therapist

Phone

(919) 561-9663

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Anna Bengtson Broadwell, LCMHC

  • Mental Health Counselor
  • Angier, NC
  • NPI 1295225373
  NPD Authorized official

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

{
    "created_epoch": "1603670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603670400000",
    "number": "1346840873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37501",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276277501",
            "telephone_number": "919-249-8675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7427 OLD STAGE RD N",
            "city": "ANGIER",
            "state": "NC",
            "postal_code": "275017401",
            "telephone_number": "919-561-9663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN THERAPEUTIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-26",
        "last_updated": "2020-10-26",
        "certification_date": "2020-10-26",
        "status": "A",
        "authorized_official_last_name": "BROADWELL",
        "authorized_official_first_name": "ANNA",
        "authorized_official_middle_name": "BENGTSON",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "919-561-9663",
        "authorized_official_credential": "MA, MDIV, LCMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Jo Dexter, OD
• Rachel Lorraine Dinunzio, QMHP
• E & E Medical Transportation
• Virginia Ann Edwards, PH.D.
• Alyson Evancho
• First Choice Community Health Centers (Angier Medical Center)
• Tauscha Alyse Gerald, FNP
• Jamila German
• Whitney Johnson Gilmore, MS, CCC-SLP
• Golden Spine Chiropractic PLLC

• Mental Health Counselor in Angier, NC
• Providers in Angier, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2020; 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.