Provider Demographics
NPI:1922007392
Name:INTERACTIVE RESOURCES, LLC
Entity Type:Organization
Organization Name:INTERACTIVE RESOURCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR - COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:MASSANARI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MS-LPC
Authorized Official - Phone:828-251-1948
Mailing Address - Street 1:PO BOX 18958
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28814-0958
Mailing Address - Country:US
Mailing Address - Phone:828-251-1948
Mailing Address - Fax:828-299-7454
Practice Address - Street 1:150 CHATHAM RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-3361
Practice Address - Country:US
Practice Address - Phone:828-251-1948
Practice Address - Fax:828-299-7454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2013-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNCLPC #2280101Y00000X
FLLMHC #1834101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1187UOtherBLUE CROSS BLUE SHIELD