Provider Demographics
NPI:1841798212
Name:EVERHART, CJ WILD (LMHC)
Entity type:Individual
Prefix:
First Name:CJ
Middle Name:WILD
Last Name:EVERHART
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60071
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-0071
Mailing Address - Country:US
Mailing Address - Phone:617-417-1055
Mailing Address - Fax:
Practice Address - Street 1:139 NONOTUCK ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-1907
Practice Address - Country:US
Practice Address - Phone:617-417-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007547101YM0800X
MA12340-MH-CC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1235928029OtherNPI