MEDICARE: ANDREA H BEACH LCMHCA

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	101YM0800X	Mental Health Counselor	A18879	NC

General Provider Information

NPI Number	:	1205515285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA H BEACH LCMHCA

Provider Business Mailing Address
First Line	:	7752 GATEWAY LN NW
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-4414
Country	:	US
Telephone Number	:	704-896-7776
Fax Number	:	704-896-0992

Provider Business Practice Location Address
First Line	:	7752 GATEWAY LN NW
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-4414
Country	:	US
Telephone Number	:	704-896-7776
Fax Number	:	704-896-0992

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2023
Last Update Date	:	07/17/2023

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