Provider Demographics
NPI:1063634442
Name:BEANE, SHANTRA (LPC, LCAS)
Entity type:Individual
Prefix:
First Name:SHANTRA
Middle Name:
Last Name:BEANE
Suffix:
Gender:F
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5807 HARVEST SPRINGS DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-8045
Mailing Address - Country:US
Mailing Address - Phone:336-963-4517
Mailing Address - Fax:
Practice Address - Street 1:3821 FORRESTGATE DR
Practice Address - Street 2:DBA FORSYTH BEHAVIOR HEALTH
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2930
Practice Address - Country:US
Practice Address - Phone:336-277-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4302101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor