Healthcare Provider Details

I. General information

NPI: 1619439643
Provider Name (Legal Business Name): JASON WILLIAM MAKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2019
Last Update Date: 03/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 ROBERTS RD STE 103
ASHEVILLE NC
28803-6631
US

IV. Provider business mailing address

53 LIBERTY CIR
CANDLER NC
28715-9448
US

V. Phone/Fax

Practice location:
  • Phone: 828-505-3086
  • Fax:
Mailing address:
  • Phone: 828-708-3531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number24677
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP012873
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: