Healthcare Provider Details

I. General information

NPI: 1912925314
Provider Name (Legal Business Name): ALAN BEACH PH.D., LCSW, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 S COLLEGE AVE
SALEM VA
24153-5165
US

IV. Provider business mailing address

811 S COLLEGE AVE
SALEM VA
24153-5165
US

V. Phone/Fax

Practice location:
  • Phone: 540-387-3977
  • Fax: 540-387-3988
Mailing address:
  • Phone: 540-387-3977
  • Fax: 540-387-3988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904001814
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: