Healthcare Provider Details

I. General information

NPI: 1144847377
Provider Name (Legal Business Name): AMICA MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2020
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CENTRAL AVE
ASHEVILLE NC
28801-2419
US

IV. Provider business mailing address

25 STARS FOREVER DR
BLACK MOUNTAIN NC
28711-8845
US

V. Phone/Fax

Practice location:
  • Phone: 828-215-9888
  • Fax: 855-962-2344
Mailing address:
  • Phone: 828-215-9888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARIA MACDOUGALL
Title or Position: OWNER
Credential: NP
Phone: 828-215-9888