Provider Demographics
NPI:1619613833
Name:BEASON, MATTHEW (LCHMC-A, LCAS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BEASON
Suffix:
Gender:M
Credentials:LCHMC-A, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 REVONDA DR
Mailing Address - Street 2:
Mailing Address - City:WOODFIN
Mailing Address - State:NC
Mailing Address - Zip Code:28804-3013
Mailing Address - Country:US
Mailing Address - Phone:858-335-5826
Mailing Address - Fax:
Practice Address - Street 1:4 REVONDA DR
Practice Address - Street 2:
Practice Address - City:WOODFIN
Practice Address - State:NC
Practice Address - Zip Code:28804-3013
Practice Address - Country:US
Practice Address - Phone:858-335-5826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16115101YM0800X
NCLCAS-26771101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health