Provider Demographics
NPI:1124570908
Name:BEATY RECOVERY SERVICES LLC
Entity Type:Organization
Organization Name:BEATY RECOVERY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:BEATY
Authorized Official - Last Name:CLONINGER
Authorized Official - Suffix:
Authorized Official - Credentials:CCS, LCAS
Authorized Official - Phone:704-864-3900
Mailing Address - Street 1:436 E LONG AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2516
Mailing Address - Country:US
Mailing Address - Phone:704-864-3900
Mailing Address - Fax:704-864-3988
Practice Address - Street 1:436 E LONG AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2516
Practice Address - Country:US
Practice Address - Phone:704-864-3900
Practice Address - Fax:704-864-3988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6008703101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty