Provider Demographics
NPI:1326140609
Name:SYLVA CLINICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:SYLVA CLINICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHIMENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-586-5555
Mailing Address - Street 1:186 MEDICAL PARK LP
Mailing Address - Street 2:SUITE 502
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779
Mailing Address - Country:US
Mailing Address - Phone:828-568-5555
Mailing Address - Fax:828-586-5555
Practice Address - Street 1:186 MEDICAL PARK LP
Practice Address - Street 2:SUITE 502
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779
Practice Address - Country:US
Practice Address - Phone:828-568-5555
Practice Address - Fax:828-586-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0251COtherBLUE CROSS BLUE SHIELD
NC6001904Medicaid
NC6001904Medicaid