Provider Demographics
NPI:1003480807
Name:BEATTY, REBECCA (NCMHC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:BEATTY
Suffix:
Gender:F
Credentials:NCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 E STONEWALL ST APT 335
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-3438
Mailing Address - Country:US
Mailing Address - Phone:985-705-4080
Mailing Address - Fax:
Practice Address - Street 1:8201 ARROWRIDGE BLVD STE 148
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-5865
Practice Address - Country:US
Practice Address - Phone:704-207-0995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16509101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health