Provider Demographics
NPI:1346336286
Name:SPIRA, BETH (PSYD)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:SPIRA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:VICTORIA
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:151 E ROSEMARY ST STE 207
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-3539
Mailing Address - Country:US
Mailing Address - Phone:919-636-1424
Mailing Address - Fax:
Practice Address - Street 1:151 E ROSEMARY ST STE 207
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-3539
Practice Address - Country:US
Practice Address - Phone:919-636-1424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16328103T00000X
NC6534103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY163280Medicaid