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General NPI Number Information
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NPI Number | 1831560556
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Entity Type | Organization
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Legal Business Name | BLUE MOUNTAIN CHILD & ADOLESCENT DEVELOPMENT CENTER
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Dates
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Enumeration Date | 10/08/2015
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Last Update Date | 10/08/2015
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Provider Practice Location Address
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Address Line | 7 YORKSHIRE STREET SUITE C2
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City | ASHEVILLE
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State | NC
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Zip | 28803
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Country | US
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Telephone | 828-412-3227
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Fax | 828-303-2524
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Provider Business Mailing Address
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Address Line | 7 YORKSHIRE STREET SUITE C2
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City | ASHEVILLE
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State | NC
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Zip | 28803
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Country | US
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Telephone | 828-412-3227
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Fax | 828-303-2524
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. AMY PALMER
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Credential | PH.D.
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Telephone | 828-772-4840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3629
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License Number State | NC
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