MEDICARE: BEHAVIORAL ASSOCIATES OF ASHEBORO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C000113	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	48811	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	019565	OTHER	NC	VALUE OPTIONS

General Provider Information

NPI Number	:	1184661738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL ASSOCIATES OF ASHEBORO

Provider Business Mailing Address
First Line	:	547 N FAYETTEVILLE ST
Second Line	:
City	:	ASHEBORO
State	:	NC
Zip	:	27203-4725
Country	:	US
Telephone Number	:	336-629-7112
Fax Number	:

Provider Business Practice Location Address
First Line	:	547 N FAYETTEVILLE ST
Second Line	:
City	:	ASHEBORO
State	:	NC
Zip	:	27203-4725
Country	:	US
Telephone Number	:	336-629-7112
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HELEN LEE KEYES
Credential	:	MSW, LCSW
Telephone Number	:	336-629-7112

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	08/22/2020

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