Provider Demographics
NPI:1164776589
Name:BESWICK, MICHAEL ALLEN (LICSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALLEN
Last Name:BESWICK
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 HARPER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3376
Mailing Address - Country:US
Mailing Address - Phone:681-238-5733
Mailing Address - Fax:
Practice Address - Street 1:1802 HARPER RD STE 200
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3376
Practice Address - Country:US
Practice Address - Phone:681-238-5733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP02943125322D00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children