Provider Demographics
NPI:1073889440
Name:GERVASI, JOLENE
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:GERVASI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 N LOUISIANA AVE STE A2
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3648
Mailing Address - Country:US
Mailing Address - Phone:828-225-4980
Mailing Address - Fax:828-225-4822
Practice Address - Street 1:370 N LOUISIANA AVE STE A2
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-3648
Practice Address - Country:US
Practice Address - Phone:828-225-4980
Practice Address - Fax:828-225-4822
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NC9275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health