Healthcare Provider Details

I. General information

NPI: 1811714884
Provider Name (Legal Business Name): HENDERSON BEASLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 HENDERSONVILLE RD STE 202
ASHEVILLE NC
28803-3245
US

IV. Provider business mailing address

12 BULL MOUNTAIN RD
ASHEVILLE NC
28805-1504
US

V. Phone/Fax

Practice location:
  • Phone: 828-333-9320
  • Fax:
Mailing address:
  • Phone: 970-333-0246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA20514
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: