Healthcare Provider Details

I. General information

NPI: 1891727681
Provider Name (Legal Business Name): SOUTHERN HIGHLANDS PSYCHOLOGICAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 COLLEGE PL SUITE D-203
ASHEVILLE NC
28801-2483
US

IV. Provider business mailing address

31 COLLEGE PL SUITE D-203
ASHEVILLE NC
28801-2483
US

V. Phone/Fax

Practice location:
  • Phone: 828-350-1433
  • Fax: 828-350-1434
Mailing address:
  • Phone: 828-350-1433
  • Fax: 828-350-1434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1863
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCOO5255
License Number StateNC

VIII. Authorized Official

Name: DR. CHARLES MARK KNECHT
Title or Position: PSYCHOLOGIST
Credential: PSY,D
Phone: 828-350-1433