Provider Information for 1770817918
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Mr. MATTHEW SAMUEL BEAL LPC
Sex: Male
NPI: 1770817918
Last Updated: 2020-04-20
Certification Date: 2020-04-20
Certification Date: 2020-04-20
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1770817918 | ||||||||||||
| Enumeration Date | 2009-09-21 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 124 S TONEY ST SHELBY, NC 28152-7735 United States Phone: 254-251-0060 | Fax: | ||||||||||||
| Primary Practice Address | 609 S NEW HOPE RD STE 102 GASTONIA, NC 28054-4825 United States Phone: 704-208-1865 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 124 S TONEY ST | ||||||||||||
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