Healthcare Provider Details

I. General information

NPI: 1497298228
Provider Name (Legal Business Name): ALIREZA ZIBAIE MS. LCAS-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 HAYWOOD RD. SUITE A
ASHEVILLE NC
28806
US

IV. Provider business mailing address

775 HAYWOOD RD SUITE A
ASHEVILLE NC
28806-3159
US

V. Phone/Fax

Practice location:
  • Phone: 828-412-9112
  • Fax:
Mailing address:
  • Phone: 828-412-9112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number22446
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: