Healthcare Provider Details

I. General information

NPI: 1922485291
Provider Name (Legal Business Name): JENNIFER GURAL LCASA 20323
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 TUNNEL RD SUITE D
ASHEVILLE NC
28805-1869
US

IV. Provider business mailing address

212 PENNSYLVANIA AVE
ASHEVILLE NC
28806-3365
US

V. Phone/Fax

Practice location:
  • Phone: 828-350-1000
  • Fax:
Mailing address:
  • Phone: 662-648-0249
  • Fax: 828-350-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS 20323
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: