Provider Demographics
NPI:1093300667
Name:BEATTY, JALECIA ALEXANDRIA (LCMHCA)
Entity Type:Individual
Prefix:
First Name:JALECIA
Middle Name:ALEXANDRIA
Last Name:BEATTY
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 EDGERTON DR APT 116
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2686
Mailing Address - Country:US
Mailing Address - Phone:919-559-1998
Mailing Address - Fax:
Practice Address - Street 1:10500 LIGON MILL RD STE 101
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4576
Practice Address - Country:US
Practice Address - Phone:919-457-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16246101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty