MEDICARE: EUGENA ERLINA BEARD CACII

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CACII1098	DC
2	101Y00000X	Counselor	CACII1098	DC

General Provider Information

NPI Number	:	1902377997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENA ERLINA BEARD CACII

Provider Business Mailing Address
First Line	:	6200 MARDELLA BLVD
Second Line	:
City	:	CLINTON
State	:	MD
Zip	:	20735-2234
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 GOOD HOPE RD SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-6912
Country	:	US
Telephone Number	:	202-610-1886
Fax Number	:

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

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	02/17/2025

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