Provider Demographics
NPI:1932513132
Name:WILLOW WELLNESS AND RECOVERY CENTER PC
Entity Type:Organization
Organization Name:WILLOW WELLNESS AND RECOVERY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ILONA
Authorized Official - Middle Name:
Authorized Official - Last Name:CSAPO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-792-0304
Mailing Address - Street 1:25 ORANGE ST STE B
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2328
Mailing Address - Country:US
Mailing Address - Phone:828-772-6715
Mailing Address - Fax:
Practice Address - Street 1:25 ORANGE ST STE B
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2328
Practice Address - Country:US
Practice Address - Phone:828-772-6715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC9497101YP2500X
NC2009-013242084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty