Provider Demographics
NPI:1508115296
Name:CHURCH, ANTHONY LEE (LCMHC, LCAS-A)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:LEE
Last Name:CHURCH
Suffix:
Gender:M
Credentials:LCMHC, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 5TH AVE E
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-4377
Mailing Address - Country:US
Mailing Address - Phone:828-692-4289
Mailing Address - Fax:828-696-1794
Practice Address - Street 1:65 N BROAD ST
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-3725
Practice Address - Country:US
Practice Address - Phone:828-631-3973
Practice Address - Fax:828-631-9280
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-27760101YA0400X
NCC0099771041C0700X
NC9021101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical