Provider Demographics
NPI:1356664916
Name:BEHAVIOR EDUCATION AND RESOURCE SPECIALISTS, INC
Entity Type:Organization
Organization Name:BEHAVIOR EDUCATION AND RESOURCE SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-537-6799
Mailing Address - Street 1:1609 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-4103
Mailing Address - Country:US
Mailing Address - Phone:252-537-6799
Mailing Address - Fax:252-537-6793
Practice Address - Street 1:1609 E 10TH ST
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4103
Practice Address - Country:US
Practice Address - Phone:252-537-6799
Practice Address - Fax:252-537-6793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 104100000X, 106H00000X
NC251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC018KKOtherBCBS
NC018KKOtherHEALTH CHOICE
NC8300824GMedicaid
NC8300824HMedicaid
NC8300824BMedicaid
NC1962548834Medicaid