Provider Demographics
NPI:1205392156
Name:CASSIDY, PAUL SCOTT (BA, QP, CSAC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:SCOTT
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:BA, QP, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1536
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28680-1536
Mailing Address - Country:US
Mailing Address - Phone:828-437-3000
Mailing Address - Fax:828-274-6377
Practice Address - Street 1:6 ROBERTS RD STE 103
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-6631
Practice Address - Country:US
Practice Address - Phone:828-505-3086
Practice Address - Fax:828-274-6377
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCSAC-23855101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)