Provider Demographics
NPI:1205458569
Name:BEISECKER, LING (LCMHC)
Entity type:Individual
Prefix:
First Name:LING
Middle Name:
Last Name:BEISECKER
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 VILLAGE CIRCLE WAY APT 1434
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6148
Mailing Address - Country:US
Mailing Address - Phone:540-320-2831
Mailing Address - Fax:
Practice Address - Street 1:976 MARTIN LUTHER KING JR BLVD STE D
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2611
Practice Address - Country:US
Practice Address - Phone:540-302-2719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-09
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15689101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional