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General NPI Number Information
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NPI Number | 1780043166
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Entity Type | Organization
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Legal Business Name | ASPEN ROOTS COLLECTIVE, PLLC
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Dates
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Enumeration Date | 02/15/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 390 MERRIMON AVE
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City | ASHEVILLE
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State | NC
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Zip | 28801-1222
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Country | US
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Telephone | 828-808-7858
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Fax |
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Provider Business Mailing Address
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Address Line | 44 HARVARD PL
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City | ASHEVILLE
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State | NC
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Zip | 28806-2532
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Country | US
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Telephone | 828-808-7858
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | SOMMERVILLE BEVILAQUA
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Credential | LPC
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Telephone | 828-808-7858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 9133
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License Number State | NC
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