Provider Demographics
NPI:1811305832
Name:BECKWITH, THOMAS (LPC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BECKWITH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3414 REGIMENT DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4625
Mailing Address - Country:US
Mailing Address - Phone:910-487-0242
Mailing Address - Fax:
Practice Address - Street 1:3414 REGIMENT DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4625
Practice Address - Country:US
Practice Address - Phone:910-487-0242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7832101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health