=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922007392
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTERACTIVE RESOURCES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2005
-----------------------------------------------------
Last Update Date | 06/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 CHATHAM RD
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28804-3361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-251-1948
-----------------------------------------------------
Fax | 828-299-7454
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 18958
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28814-0958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-251-1948
-----------------------------------------------------
Fax | 828-299-7454
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR - COUNSELOR
-----------------------------------------------------
Name | DR. JARED DEAN MASSANARI
-----------------------------------------------------
Credential | PH.D, MS-LPC
-----------------------------------------------------
Telephone | 828-251-1948
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | LMHC #1834
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | NCLPC #2280
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------