Provider Demographics
NPI:1184661738
Name:BEHAVIORAL ASSOCIATES OF ASHEBORO
Entity Type:Organization
Organization Name:BEHAVIORAL ASSOCIATES OF ASHEBORO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KEYES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:336-629-7112
Mailing Address - Street 1:547 N FAYETTEVILLE ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-4725
Mailing Address - Country:US
Mailing Address - Phone:336-629-7112
Mailing Address - Fax:
Practice Address - Street 1:547 N FAYETTEVILLE ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4725
Practice Address - Country:US
Practice Address - Phone:336-629-7112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0001131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC48811OtherBCBS
NC6002426Medicaid
NC019565OtherVALUE OPTIONS
NC48811OtherBCBS