Provider Demographics
NPI:1972966059
Name:RUPP, BETH NOEL (LCSWA, LCASA)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:NOEL
Last Name:RUPP
Suffix:
Gender:F
Credentials:LCSWA, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 HAY ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5366
Mailing Address - Country:US
Mailing Address - Phone:910-483-2695
Mailing Address - Fax:910-263-8295
Practice Address - Street 1:907 HAY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5366
Practice Address - Country:US
Practice Address - Phone:910-483-2695
Practice Address - Fax:910-263-8295
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21539101YA0400X
NCP0088061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
104100000XOtherIPRS
NC104100000XMedicaid