MEDICARE: MS. BEATRICE ELLISON NCC, LPCS, LCMHCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	S5580	NC
2	101YM0800X	Mental Health Counselor	S5580	NC

General Provider Information

NPI Number	:	1588729313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BEATRICE ELLISON NCC, LPCS, LCMHCS

Provider Business Mailing Address
First Line	:	250 MAGNOLIA SQUARE CT
Second Line	:
City	:	ABERDEEN
State	:	NC
Zip	:	28315-2226
Country	:	US
Telephone Number	:	910-944-0938
Fax Number	:	910-944-0940

Provider Business Practice Location Address
First Line	:	250 MAGNOLIA SQ COURT
Second Line	:
City	:	ABERDEEN
State	:	NC
Zip	:	28315-2226
Country	:	US
Telephone Number	:	910-944-0938
Fax Number	:	910-944-0940

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	04/29/2025

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