Healthcare Provider Details

I. General information

NPI: 1730226721
Provider Name (Legal Business Name): BEHAVIOR EDUCATION AND RESOURCE SPECIALIST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 E 10TH ST
ROANOKE RAPIDS NC
27870-4103
US

IV. Provider business mailing address

1609 E 10TH ST
ROANOKE RAPIDS NC
27870-4103
US

V. Phone/Fax

Practice location:
  • Phone: 252-537-6799
  • Fax: 252-537-6793
Mailing address:
  • Phone: 252-537-6799
  • Fax: 252-537-6793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANDI BENNETT
Title or Position: FINANCE MANAGER
Credential:
Phone: 252-537-6799