Provider Demographics
NPI:1235140302
Name:AVERY, KAREN MIDYETTE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MIDYETTE
Last Name:AVERY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 NEWTOWN RD
Mailing Address - Street 2:STE 625
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4808
Mailing Address - Country:US
Mailing Address - Phone:757-461-3313
Mailing Address - Fax:757-461-8363
Practice Address - Street 1:6330 NEWTOWN RD
Practice Address - Street 2:STE 625
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4808
Practice Address - Country:US
Practice Address - Phone:757-461-3313
Practice Address - Fax:757-461-8363
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R58628Medicare UPIN