1407370661 NPI number — ASHEVILLE INTEGRATED BEHAVIORAL HEALTH, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407370661 NPI number — ASHEVILLE INTEGRATED BEHAVIORAL HEALTH, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASHEVILLE INTEGRATED BEHAVIORAL HEALTH, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407370661
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
186 CISCO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28805-1339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-337-6100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 CLAYTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28801-2424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-423-0537
Provider Business Practice Location Address Fax Number:
828-333-4362
Provider Enumeration Date:
07/31/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HAMILTON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
828-423-0537

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  0502 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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