=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982392239
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOUNTAIN COUNSELING WORKS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2023
-----------------------------------------------------
Last Update Date | 04/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44 MERRIMON AVE STE E
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28801-2360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-778-9902
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23 HEATHERLY DR
-----------------------------------------------------
City | CANDLER
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28715-9557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-778-9921
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EMPLOYEE
-----------------------------------------------------
Name | CAROLYN MCCARTER WOOD
-----------------------------------------------------
Credential | LCSW, LCAS, CEDS
-----------------------------------------------------
Telephone | 828-778-9902
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------