Provider Demographics
NPI:1669638821
Name:APPALACHIAN COUNSELING OUTPATIENT
Entity Type:Organization
Organization Name:APPALACHIAN COUNSELING OUTPATIENT
Other - Org Name:TAPESTRY RESIDENTIAL EATING DISORDER PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:HUSTED
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-639-9657
Mailing Address - Street 1:119 TUNNEL RD STE B
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-1800
Mailing Address - Country:US
Mailing Address - Phone:828-350-1000
Mailing Address - Fax:828-350-1300
Practice Address - Street 1:11 N COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-8908
Practice Address - Country:US
Practice Address - Phone:828-884-2475
Practice Address - Fax:828-884-2187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-045-121261QM0855X
320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness