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General NPI Number Information
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NPI Number | 1407407182
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Entity Type | Organization
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Legal Business Name | ASCENSION THERAPEUTIC SERVICES INC
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Dates
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Enumeration Date | 09/24/2019
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Last Update Date | 09/24/2019
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Provider Practice Location Address
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Address Line | 1736 DICKERSON BLVD STE 143
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City | MONROE
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State | NC
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Zip | 28110-2832
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Country | US
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Telephone | 704-418-1554
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Fax |
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Provider Business Mailing Address
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Address Line | 1736 DICKERSON BLVD STE 143
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City | MONROE
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State | NC
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Zip | 28110-2832
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Country | US
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Telephone | 704-418-1554
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TAMARA DANITA SMITH
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Credential |
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Telephone | 704-418-1554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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