Provider Demographics
NPI:1225314586
Name:BLACK MOUNTAIN COUNSELING CENTER
Entity Type:Organization
Organization Name:BLACK MOUNTAIN COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-669-9798
Mailing Address - Street 1:201 N RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-3506
Mailing Address - Country:US
Mailing Address - Phone:828-669-9798
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
Practice Address - Country:US
Practice Address - Phone:828-669-9798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6008443Medicaid
NC1225314586Medicaid