Healthcare Provider Details

I. General information

NPI: 1356664916
Provider Name (Legal Business Name): BEHAVIOR EDUCATION AND RESOURCE SPECIALISTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 06/28/2010
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 TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

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