=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629880919
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GRAHAM AUSTEN TOLBERT LCMHCA, LCAS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2025
-----------------------------------------------------
Last Update Date | 03/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 802 FAIRVIEW RD OFC 4
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28803-1171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-367-7719
-----------------------------------------------------
Fax | 828-820-5503
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 165 ONTEORA BLVD
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28803-1050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-367-7719
-----------------------------------------------------
Fax | 828-820-5503
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | LCAS-28873
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | A21199
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------