Healthcare Provider Details

I. General information

NPI: 1841555794
Provider Name (Legal Business Name): NORTH BEECH STREET GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 07/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 BEECH ST
GREENSBORO NC
27401-3115
US

IV. Provider business mailing address

502 BEECH ST
GREENSBORO NC
27401-3115
US

V. Phone/Fax

Practice location:
  • Phone: 336-275-0627
  • Fax:
Mailing address:
  • Phone: 336-275-0627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: BETTIE DAVIS
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 336-275-0627