Provider Demographics
NPI:1659060820
Name:BEACON OF HOPE
Entity Type:Organization
Organization Name:BEACON OF HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED BEHAVIORAL TECHNICIAN
Authorized Official - Prefix:MISS
Authorized Official - First Name:ATHENA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:RBT
Authorized Official - Phone:334-804-4476
Mailing Address - Street 1:20101 NELSON RD
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36421-7659
Mailing Address - Country:US
Mailing Address - Phone:334-804-4476
Mailing Address - Fax:
Practice Address - Street 1:181 W REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-1438
Practice Address - Country:US
Practice Address - Phone:334-379-0729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty