Provider Demographics
NPI:1326715657
Name:BEAM, KATHRYN (LCMHCA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BEAM
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3503 CHANCE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8437
Mailing Address - Country:US
Mailing Address - Phone:336-337-4052
Mailing Address - Fax:
Practice Address - Street 1:2110 GOLDEN GATE DR STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5619
Practice Address - Country:US
Practice Address - Phone:336-429-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13612101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health