Basic Information
| Provider Information | |||||||||
| NPI: | 1568128379 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNTAIN MENTAL HEALTH AND WELLNESS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 BRASSIE CT | ||||||||
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| City: | CANDLER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287150108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282436325 | ||||||||
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| Practice Location | |||||||||
| Address1: | 65 MERRIMON AVE # 1043 | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288012322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284080432 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2021 | ||||||||
| LastUpdateDate: | 03/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | HOWARD | ||||||||
| AuthorizedOfficialFirstName: | SANDY | ||||||||
| AuthorizedOfficialMiddleName: | NIEMCZYK | ||||||||
| AuthorizedOfficialTitleorPosition: | NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 8282436325 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
| NPICertificationDate: | 03/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.