Provider Demographics
NPI:1841639275
Name:WESTERN NORTH CAROLINA BEHAVIORAL EDUCATION, SERVICES & TREATMENT, PA
Entity type:Organization
Organization Name:WESTERN NORTH CAROLINA BEHAVIORAL EDUCATION, SERVICES & TREATMENT, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:CAROLINE
Authorized Official - Last Name:MINICOZZI
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP, BCBA
Authorized Official - Phone:828-778-2378
Mailing Address - Street 1:13 BRUCEMONT CIR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3402
Mailing Address - Country:US
Mailing Address - Phone:828-778-2378
Mailing Address - Fax:
Practice Address - Street 1:13 BRUCEMONT CIR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-3402
Practice Address - Country:US
Practice Address - Phone:828-778-2378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1073879251S00000X
NC6274252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251S00000XAgenciesCommunity/Behavioral Health