Healthcare Provider Details

I. General information

NPI: 1831007012
Provider Name (Legal Business Name): MOUNTAINSIDE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 FAIRVIEW RD STE 4000
ASHEVILLE NC
28803-1170
US

IV. Provider business mailing address

997 FLAT TOP MOUNTAIN RD
FAIRVIEW NC
28730-6518
US

V. Phone/Fax

Practice location:
  • Phone: 309-361-3031
  • Fax:
Mailing address:
  • Phone: 309-361-3031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KELLY LEE KIMMERLING
Title or Position: OWNER
Credential: LCMHC
Phone: 309-361-3031