Provider Demographics
NPI:1710057476
Name:BEATTY, DANIEL RICHARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:RICHARD
Last Name:BEATTY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:RICHARD
Other - Last Name:BEATTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:219A AVERY AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3102
Mailing Address - Country:US
Mailing Address - Phone:828-430-8344
Mailing Address - Fax:828-430-4384
Practice Address - Street 1:219A AVERY AVE
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3102
Practice Address - Country:US
Practice Address - Phone:828-430-8344
Practice Address - Fax:828-430-4384
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC004809104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003109Medicaid