Provider Demographics
NPI:1912546573
Name:BEACON THERAPEUTIC AND WELLNESS SERVICES
Entity Type:Organization
Organization Name:BEACON THERAPEUTIC AND WELLNESS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:MEREDITH
Authorized Official - Last Name:ESCALANTE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-627-0987
Mailing Address - Street 1:2900 ARNOLD RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2852
Mailing Address - Country:US
Mailing Address - Phone:919-627-0987
Mailing Address - Fax:
Practice Address - Street 1:3201 YORKTOWN AVE STE 117E
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-1474
Practice Address - Country:US
Practice Address - Phone:919-627-0987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-31
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty