Provider Demographics
NPI:1558138818
Name:AVERZA, PABLO JAVIER (LCMHCA)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:JAVIER
Last Name:AVERZA
Suffix:
Gender:M
Credentials:LCMHCA
Other - Prefix:
Other - First Name:PABLO
Other - Middle Name:JAVIER
Other - Last Name:AVERZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCMHCA
Mailing Address - Street 1:626 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-3820
Mailing Address - Country:US
Mailing Address - Phone:828-283-0113
Mailing Address - Fax:
Practice Address - Street 1:626 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3820
Practice Address - Country:US
Practice Address - Phone:828-283-0113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19439101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health