Healthcare Provider Details

I. General information

NPI: 1215208657
Provider Name (Legal Business Name): SOUTHMOUNTAIN CHILDREN AND FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8076 NC HIGHWAY 105 S
BOONE NC
28607
US

IV. Provider business mailing address

PO BOX 3387
MORGANTON NC
28680-3387
US

V. Phone/Fax

Practice location:
  • Phone: 828-584-1105
  • Fax:
Mailing address:
  • Phone: 828-391-2803
  • Fax: 828-584-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM CHRIS JERNIGAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 828-584-1105