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General NPI Number Information
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NPI Number | 1124570908
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Entity Type | Organization
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Legal Business Name | BEATY RECOVERY SERVICES LLC
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 436 E LONG AVE SUITE 2
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City | GASTONIA
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State | NC
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Zip | 28054-2516
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Country | US
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Telephone | 704-864-3900
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Fax | 704-864-3988
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Provider Business Mailing Address
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Address Line | 436 E LONG AVE SUITE 2
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City | GASTONIA
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State | NC
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Zip | 28054-2516
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Country | US
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Telephone | 704-864-3900
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Fax | 704-864-3988
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Authorized Official
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Title or Position | DIRECTOR OWNER
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Name | MS. LINDA BEATY CLONINGER
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Credential | CCS, LCAS
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Telephone | 704-864-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 6008703
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License Number State | NC
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