Provider Demographics
NPI:1518719343
Name:MARY, CLANCEY O'CONNOR (MAOM, LAC)
Entity Type:Individual
Prefix:
First Name:CLANCEY
Middle Name:O'CONNOR
Last Name:MARY
Suffix:
Gender:F
Credentials:MAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 RICHMOND HILL DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3933
Mailing Address - Country:US
Mailing Address - Phone:865-363-7306
Mailing Address - Fax:
Practice Address - Street 1:70 WOODFIN PL STE 17
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2469
Practice Address - Country:US
Practice Address - Phone:865-363-7306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2109171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist