Provider Demographics
NPI:1932427374
Name:BEYER, JESSICA MABEL (NCC, LPC, LCAS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MABEL
Last Name:BEYER
Suffix:
Gender:F
Credentials:NCC, LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 BAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-8183
Mailing Address - Country:US
Mailing Address - Phone:704-606-1727
Mailing Address - Fax:
Practice Address - Street 1:1136 SAM NEWELL RD
Practice Address - Street 2:SUITE B-2
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5063
Practice Address - Country:US
Practice Address - Phone:980-239-7910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NC7912101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1880FOtherBCBS