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General NPI Number Information
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NPI Number | 1144308396
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Entity Type | Organization
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Legal Business Name | BEATITUDE HOUSE
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 12/06/2011
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Provider Practice Location Address
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Address Line | 470 TWIN BROOK DR
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City | WAYNESVILLE
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State | NC
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Zip | 28785-8348
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Country | US
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Telephone | 828-926-5591
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Fax |
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Provider Business Mailing Address
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Address Line | 470 TWIN BROOK DR
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City | WAYNESVILLE
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State | NC
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Zip | 28785-8348
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Country | US
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Telephone | 828-926-5591
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MATTHEW H BRADLEY IV
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Credential | MSW
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Telephone | 828-926-5591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 996
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License Number State | NC
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