Healthcare Provider Details

I. General information

NPI: 1083720783
Provider Name (Legal Business Name): GENENA LYNN WADSWORTH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 CHARLOTTE ST STE 2
ASHEVILLE NC
28801-1910
US

IV. Provider business mailing address

188 CHARLOTTE ST STE 2
ASHEVILLE NC
28801-1910
US

V. Phone/Fax

Practice location:
  • Phone: 828-803-0820
  • Fax:
Mailing address:
  • Phone: 828-803-0820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-2609
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3493
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: