Provider Demographics
NPI:1619162294
Name:FARMER, ALICEINGEBORG STOLL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ALICEINGEBORG
Middle Name:STOLL
Last Name:FARMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:INGE
Other - Middle Name:
Other - Last Name:STOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:104 S. WASHINGTON ST.
Mailing Address - Street 2:KALEIDOSCOPE COUNSELING SVC
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-4962
Mailing Address - Country:US
Mailing Address - Phone:828-692-2653
Mailing Address - Fax:828-692-2627
Practice Address - Street 1:104 S. WASHINGTON ST.
Practice Address - Street 2:KALEIDOSCOPE COUNSELING SVC
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4962
Practice Address - Country:US
Practice Address - Phone:828-692-2653
Practice Address - Fax:828-692-2627
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOO57581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2853400OtherMCARE
NC6007347Medicaid