Provider Demographics
NPI:1497429435
Name:GANNON CLINICAL SERVICES PLLC
Entity type:Organization
Organization Name:GANNON CLINICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GANNON
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:828-712-8526
Mailing Address - Street 1:60 TRINITY CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-1954
Mailing Address - Country:US
Mailing Address - Phone:828-712-8526
Mailing Address - Fax:
Practice Address - Street 1:29 RAVENSCROFT DR STE 202
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3602
Practice Address - Country:US
Practice Address - Phone:828-712-8526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty