Basic Information
| Provider Information | |||||||||
| NPI: | 1669845137 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANNARINO | ||||||||
| FirstName: | MISTY | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | LPCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 PURRFECT VIEW DR | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287166315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283355895 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6 ROBERTS RD STE 105 | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288038699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282771315 | ||||||||
| FaxNumber: | 8282771321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2015 | ||||||||
| LastUpdateDate: | 03/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 21894 | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | A14610 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 21894 | 01 | NC | NC SUBSTANCE ABUSE PROFESSIONAL PRACTICE BOARD | OTHER |