=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376896514
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR EMOTIONAL AND SPIRITUAL HEALING, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2012
-----------------------------------------------------
Last Update Date | 10/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37 CHURCH ST STE 2
-----------------------------------------------------
City | WAYNESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28786-5708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-246-9500
-----------------------------------------------------
Fax | 828-246-9501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1538
-----------------------------------------------------
City | MAGGIE VALLEY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28751-1538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-246-9500
-----------------------------------------------------
Fax | 828-246-9501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | MR. TIMOTHY H HUSSEY
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 828-246-9500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | C0007936
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------