Provider Demographics
NPI:1194025643
Name:BEAL, ANETIA (LPC)
Entity type:Individual
Prefix:
First Name:ANETIA
Middle Name:
Last Name:BEAL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-7722
Mailing Address - Country:US
Mailing Address - Phone:601-410-9385
Mailing Address - Fax:
Practice Address - Street 1:707C AZALEA DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-2718
Practice Address - Country:US
Practice Address - Phone:601-410-9385
Practice Address - Fax:855-289-3955
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2664101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional