Healthcare Provider Details

I. General information

NPI: 1497367700
Provider Name (Legal Business Name): MISTY ANNARINO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HOSPITAL DR STE 8
CLYDE NC
28721-8046
US

IV. Provider business mailing address

90 PURRFECT VIEW DR
CANTON NC
28716-6315
US

V. Phone/Fax

Practice location:
  • Phone: 828-335-5895
  • Fax: 980-832-1271
Mailing address:
  • Phone: 828-335-5895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MISTY MICHELLE ANNARINO
Title or Position: OWNER
Credential: LCMHC
Phone: 828-335-5895