Healthcare Provider Details

I. General information

NPI: 1386254407
Provider Name (Legal Business Name): CASSIDY CONWAY BEARD LCAS-A, LCMHC-A, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10205 US HIGHWAY 15 501 UNIT 26
SOUTHERN PINES NC
28387-5180
US

IV. Provider business mailing address

10205 US HIGHWAY 15 501 UNIT 26 #178
SOUTHERN PINES NC
28387-5180
US

V. Phone/Fax

Practice location:
  • Phone: 984-983-5423
  • Fax: 984-220-9438
Mailing address:
  • Phone: 984-983-5423
  • Fax: 984-220-9438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1154368
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA15754
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number26227
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: