Healthcare Provider Details

I. General information

NPI: 1336639574
Provider Name (Legal Business Name): MARY ELIZABETH DEANE LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 TUNNEL RD STE D
ASHEVILLE NC
28805-1800
US

IV. Provider business mailing address

38 QUEEN RD # D
CANDLER NC
28715-9257
US

V. Phone/Fax

Practice location:
  • Phone: 828-350-1000
  • Fax: 833-913-0081
Mailing address:
  • Phone: 828-215-0813
  • Fax: 828-215-0813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCASA-24821
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13484
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA13484
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: