Provider Demographics
NPI:1336639574
Name:DEANE, MARY ELIZABETH (LPCA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:DEANE
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 QUEEN RD # D
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-9257
Mailing Address - Country:US
Mailing Address - Phone:828-215-0813
Mailing Address - Fax:828-215-0813
Practice Address - Street 1:119 TUNNEL RD STE D
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-1800
Practice Address - Country:US
Practice Address - Phone:828-350-1000
Practice Address - Fax:833-913-0081
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13484101YM0800X
NCA13484101YP2500X
NCLCASA-24821101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional