Provider Demographics
NPI:1639204662
Name:ORDWAY, MARY LOUISE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LOUISE
Last Name:ORDWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 JARNAUL AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-2249
Mailing Address - Country:US
Mailing Address - Phone:828-254-3481
Mailing Address - Fax:828-285-0103
Practice Address - Street 1:18 JARNAUL AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-2249
Practice Address - Country:US
Practice Address - Phone:828-254-3481
Practice Address - Fax:828-285-0103
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107315Medicaid