Provider Demographics
NPI:1467558122
Name:AMMERMAN, MARY C (PSYD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:AMMERMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 ZILLICOA ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-1079
Mailing Address - Country:US
Mailing Address - Phone:828-254-9494
Mailing Address - Fax:828-254-0161
Practice Address - Street 1:158 ZILLICOA ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1079
Practice Address - Country:US
Practice Address - Phone:828-254-9494
Practice Address - Fax:828-254-0161
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2990103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046F6OtherBCBS OF NC
NC6000709Medicaid
NC2822527Medicare ID - Type Unspecified