MEDICARE: MRS. ANNA SHUMOLIS CONN LCSWA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	P008007	NC

General Provider Information

NPI Number	:	1750704318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNA SHUMOLIS CONN LCSWA

Provider Business Mailing Address
First Line	:	1316 PATTON AVE STE D
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28806-2652
Country	:	US
Telephone Number	:	828-225-3100
Fax Number	:	828-225-3604

Provider Business Practice Location Address
First Line	:	1355 CHARLOTTE HWY
Second Line	:
City	:	FAIRVIEW
State	:	NC
Zip	:	28730-8798
Country	:	US
Telephone Number	:	828-628-2732
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2014
Last Update Date	:	01/31/2014

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