Provider Demographics
NPI:1114240272
Name:BEASON, ELEANOR M (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:M
Last Name:BEASON
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 FORT BENNING RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31903-2834
Mailing Address - Country:US
Mailing Address - Phone:706-322-9599
Mailing Address - Fax:706-221-8593
Practice Address - Street 1:1600 FORT BENNING RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31903-2834
Practice Address - Country:US
Practice Address - Phone:706-322-9599
Practice Address - Fax:706-221-8593
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1418C1041C0700X
GACSW0016201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA355976187CMedicaid
AL164144Medicaid
GA202I803955Medicare PIN