Basic Information
| Provider Information | |||||||||
| NPI: | 1255875506 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REISMAN | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 617 S GREEN ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MORGANTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286553517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284373000 | ||||||||
| FaxNumber: | 8284374999 | ||||||||
| Practice Location | |||||||||
| Address1: | 276 E CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288012036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288744100 | ||||||||
| FaxNumber: | 8284374999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2016 | ||||||||
| LastUpdateDate: | 12/06/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A12519 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | A12519 | 01 | NC | LICENSURE | OTHER |