Healthcare Provider Details

I. General information

NPI: 1548187800
Provider Name (Legal Business Name): BEACH GLASS THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 HIGHLAND WOODS RD
CHAPEL HILL NC
27517-4410
US

IV. Provider business mailing address

3600 N DUKE ST STE 1
DURHAM NC
27704-1769
US

V. Phone/Fax

Practice location:
  • Phone: 617-468-4916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: BROOKE SCHOBER MUGO
Title or Position: OWNER
Credential:
Phone: 617-468-4916