Healthcare Provider Details

I. General information

NPI: 1770662157
Provider Name (Legal Business Name): AURORA BEHAVIORAL INTERVENTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2006
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517-B ALTAPASS HWY
SPRUCE PINE NC
28777-3012
US

IV. Provider business mailing address

PO BOX 212
SPRUCE PINE NC
28777-0212
US

V. Phone/Fax

Practice location:
  • Phone: 828-766-7637
  • Fax: 828-766-7637
Mailing address:
  • Phone: 828-766-7637
  • Fax: 828-766-7637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1443
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5333
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5333
License Number StateNC

VIII. Authorized Official

Name: MS. LISA GRIGG OXENDALE
Title or Position: OWNER / CLINICAL DIRECTOR
Credential: MA, NCC, LPC, LCAS
Phone: 828-766-7637