Healthcare Provider Details

I. General information

NPI: 1255019204
Provider Name (Legal Business Name): LUKE SHORT CRC, LCMHC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 HENDERSONVILLE RD STE 202
ASHEVILLE NC
28803-3245
US

IV. Provider business mailing address

1550 HENDERSONVILLE RD STE 202
ASHEVILLE NC
28803-3245
US

V. Phone/Fax

Practice location:
  • Phone: 828-333-9320
  • Fax:
Mailing address:
  • Phone: 828-333-9320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number642058
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA18951
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: