Provider Demographics
NPI:1336577683
Name:BEAN, ANASTASIA DUBOSE (MS, NCC, LAPC)
Entity Type:Individual
Prefix:MS
First Name:ANASTASIA
Middle Name:DUBOSE
Last Name:BEAN
Suffix:
Gender:F
Credentials:MS, NCC, LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3801
Mailing Address - Country:US
Mailing Address - Phone:678-784-4293
Mailing Address - Fax:678-784-4294
Practice Address - Street 1:2050 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-3801
Practice Address - Country:US
Practice Address - Phone:678-784-4293
Practice Address - Fax:678-784-4294
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004007101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health