Healthcare Provider Details

I. General information

NPI: 1265652127
Provider Name (Legal Business Name): ELIZABETH ANNE PUTNAM LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 BILTMORE AVE
ASHEVILLE NC
28801-4504
US

IV. Provider business mailing address

PO BOX 8117
ASHEVILLE NC
28814-8117
US

V. Phone/Fax

Practice location:
  • Phone: 828-225-2785
  • Fax: 828-225-2784
Mailing address:
  • Phone: 828-301-6374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4454
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: