Provider Demographics
NPI:1427412527
Name:MCGUIRE, BETHANY (LPCA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5931 LAURIUM RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-5615
Mailing Address - Country:US
Mailing Address - Phone:865-243-0948
Mailing Address - Fax:
Practice Address - Street 1:18805 W CATAWBA AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-4608
Practice Address - Country:US
Practice Address - Phone:704-464-0065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11845101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional