Provider Demographics
NPI:1891727681
Name:SOUTHERN HIGHLANDS PSYCHOLOGICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:SOUTHERN HIGHLANDS PSYCHOLOGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:KNECHT
Authorized Official - Suffix:
Authorized Official - Credentials:PSY,D
Authorized Official - Phone:828-350-1433
Mailing Address - Street 1:31 COLLEGE PL
Mailing Address - Street 2:SUITE D-203
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2483
Mailing Address - Country:US
Mailing Address - Phone:828-350-1433
Mailing Address - Fax:828-350-1434
Practice Address - Street 1:31 COLLEGE PL
Practice Address - Street 2:SUITE D-203
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2483
Practice Address - Country:US
Practice Address - Phone:828-350-1433
Practice Address - Fax:828-350-1434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1863103T00000X
NCCOO52551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000135Medicaid
NC2323952Medicare UPIN