MEDICARE: SAVANNAH DETTMAN LCHMCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	A17349	NC

General Provider Information

NPI Number	:	1922755131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNAH DETTMAN LCHMCA

Provider Business Mailing Address
First Line	:	13 1/2 EAGLE ST STE E
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28801-3795
Country	:	US
Telephone Number	:	828-457-8043
Fax Number	:	828-372-4664

Provider Business Practice Location Address
First Line	:	13 1/2 EAGLE ST STE E
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28801-3795
Country	:	US
Telephone Number	:	828-457-8043
Fax Number	:	828-372-4664

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	06/28/2023

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