MEDICARE: WILLIAM GEORGE BEASLEY JR.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CADC-16144	NC
2	101YM0800X	Mental Health Counselor	16618	NC

General Provider Information

NPI Number	:	1912514670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM GEORGE BEASLEY JR.

Provider Business Mailing Address
First Line	:	205 SHERWOOD RD
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-5534
Country	:	US
Telephone Number	:	910-554-7870
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 SHERWOOD RD
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-5534
Country	:	US
Telephone Number	:	910-554-7870
Fax Number	:

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

Provider Enumeration Date	:	09/28/2020
Last Update Date	:	06/22/2026

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