Provider Demographics
NPI:1750309662
Name:BEACON BEHAVIORAL HEALTH, PLLC
Entity Type:Organization
Organization Name:BEACON BEHAVIORAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:O
Authorized Official - Last Name:FALK
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:919-880-7613
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:ROLESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27571-0370
Mailing Address - Country:US
Mailing Address - Phone:919-880-7613
Mailing Address - Fax:919-366-9705
Practice Address - Street 1:3207 ROGERS RD
Practice Address - Street 2:SUITE 204
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-3834
Practice Address - Country:US
Practice Address - Phone:919-880-7613
Practice Address - Fax:919-366-9705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0046321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC136FCOtherBCBSNC
NC6002797Medicaid
NC136FCOtherBCBSNC