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General NPI Number Information
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NPI Number | 1871163931
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Entity Type | Organization
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Legal Business Name | BROOKSIDE WELLNESS
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Dates
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Enumeration Date | 06/30/2021
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Last Update Date | 06/30/2021
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Provider Practice Location Address
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Address Line | 203 CEDAR HILL RD
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City | ASHEVILLE
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State | NC
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Zip | 28806-9441
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Country | US
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Telephone | 833-337-6687
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16031
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City | ASHEVILLE
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State | NC
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Zip | 28816-0031
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Country | US
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Telephone | 833-337-6687
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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 | LEE CAVENDER
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Credential | LCSW
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Telephone | 828-407-8987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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