Organization
EDGECOMBE-NASH MENTAL HEALTH CLINIC BEACON CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY RACKLEY (FINANCE OFFICER)
(252) 937-8141
Entity
Organization
Contact information
Practice address
500 NASH MEDICAL ARTS MALL, ROCKY MOUNT, NC 27804-1417
(252) 937-8141
(252) 443-9574
Mailing address
500 NASH MEDICAL ARTS MALL, ROCKY MOUNT, NC 27804-1417
(252) 937-8141
(252) 443-9574
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0182
MEDICARE GROUP NUMBER
NC
01
—
3404937
BASE PROVIDER NUMBER
NC
01
—
3404937E
ENDORSED PROVIDER NUMBER
NC
05
—
3408170
—
NC
05
—
5901411
—
NC
05
—
6005570
—
NC
05
—
8301065
—
NC
05
—
8301065G
—
NC
Enumeration date
09/20/2006
Last updated
06/18/2008
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