Provider Demographics
NPI:1003968165
Name:BEASLEY, WILLIAM GLENN (LPC,NCC,MAC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GLENN
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:LPC,NCC,MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 LAVISTA RD NE
Mailing Address - Street 2:UNIT E-8
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3854
Mailing Address - Country:US
Mailing Address - Phone:404-633-7971
Mailing Address - Fax:
Practice Address - Street 1:1261 LAVISTA RD NE
Practice Address - Street 2:UNIT E-8
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3854
Practice Address - Country:US
Practice Address - Phone:404-633-7971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000927101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional