Provider Demographics
NPI:1013558428
Name:LAVIN, PERRY MENDEL (LCMHC LCASA)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:MENDEL
Last Name:LAVIN
Suffix:
Gender:M
Credentials:LCMHC LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 JAKS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-1460
Mailing Address - Country:US
Mailing Address - Phone:334-322-4878
Mailing Address - Fax:
Practice Address - Street 1:201 N RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-3506
Practice Address - Country:US
Practice Address - Phone:828-669-9798
Practice Address - Fax:828-544-1080
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15125101Y00000X, 101YM0800X
NCLCAS-26602101YA0400X
NC15125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)