Provider Demographics
NPI:1104188341
Name:BEACON INSIGHT COUNSELING
Entity Type:Organization
Organization Name:BEACON INSIGHT COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:478-662-2710
Mailing Address - Street 1:104 WHITING WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8055
Mailing Address - Country:US
Mailing Address - Phone:478-662-2710
Mailing Address - Fax:478-333-2985
Practice Address - Street 1:104 WHITING WAY STE 200
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8055
Practice Address - Country:US
Practice Address - Phone:478-662-2710
Practice Address - Fax:478-333-2985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW003584251S00000X
FLSW7900251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health