Provider Demographics
NPI:1871721878
Name:BEATTY, ADRIENNE LEIGH (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:LEIGH
Last Name:BEATTY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 RANDALL PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2590
Mailing Address - Country:US
Mailing Address - Phone:910-202-9337
Mailing Address - Fax:910-769-4447
Practice Address - Street 1:3114 RANDALL PKWY STE 1
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2590
Practice Address - Country:US
Practice Address - Phone:910-202-9337
Practice Address - Fax:910-769-4447
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7381101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional