MEDICARE: MS. ANASTASIA DUBOSE BEAN MS, NCC, LAPC

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	APC004007	GA

General Provider Information

NPI Number	:	1336577683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANASTASIA DUBOSE BEAN MS, NCC, LAPC

Provider Business Mailing Address
First Line	:	2050 ROSWELL RD
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-3801
Country	:	US
Telephone Number	:	678-784-4293
Fax Number	:	678-784-4294

Provider Business Practice Location Address
First Line	:	2050 ROSWELL RD
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-3801
Country	:	US
Telephone Number	:	678-784-4293
Fax Number	:	678-784-4294

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

Provider Enumeration Date	:	10/24/2013
Last Update Date	:	10/24/2013

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