Provider Demographics
NPI:1912514670
Name:BEASLEY, WILLIAM GEORGE JR
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GEORGE
Last Name:BEASLEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-5534
Mailing Address - Country:US
Mailing Address - Phone:910-554-7870
Mailing Address - Fax:
Practice Address - Street 1:205 SHERWOOD RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5534
Practice Address - Country:US
Practice Address - Phone:910-554-7870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCADC-16144101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)