Provider Demographics
NPI:1215369095
Name:MACON, ANTHONY (BA, LCSW, LCAS-A)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:MACON
Suffix:
Gender:M
Credentials:BA, LCSW, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 TUNNEL RD STE F
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-1869
Mailing Address - Country:US
Mailing Address - Phone:828-606-4705
Mailing Address - Fax:828-774-5726
Practice Address - Street 1:119 TUNNEL RD STE F
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-1869
Practice Address - Country:US
Practice Address - Phone:828-606-4705
Practice Address - Fax:828-774-5726
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-24302101YA0400X
NCC0130661041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP011935OtherLCSW-A
NCLCAS-24302OtherLCAS-A