Provider Demographics
NPI:1053571901
Name:BRITTAIN, BETH GRAY (MDIV LPC, LMBT)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:GRAY
Last Name:BRITTAIN
Suffix:
Gender:F
Credentials:MDIV LPC, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-3718
Mailing Address - Country:US
Mailing Address - Phone:704-887-6304
Mailing Address - Fax:
Practice Address - Street 1:108 EAGLE RD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-3718
Practice Address - Country:US
Practice Address - Phone:704-887-6304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2627101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor