Healthcare Provider Details

I. General information

NPI: 1255830527
Provider Name (Legal Business Name): MARY EDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 12/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 MERRIMON AVE
ASHEVILLE NC
28801-1222
US

IV. Provider business mailing address

430 OLD FARM SCHOOL RD
ASHEVILLE NC
28805-9600
US

V. Phone/Fax

Practice location:
  • Phone: 814-880-6106
  • Fax:
Mailing address:
  • Phone: 814-880-6106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA12899
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA12899
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: