Basic Information
| Provider Information | |||||||||
| NPI: | 1811554793 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ST LOUIS | ||||||||
| FirstName: | MAKENZIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 214 GREENVILLE AVE UNIT 302 | ||||||||
| Address2: | |||||||||
| City: | ARDEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287041059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194443711 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6 ROBERTS RD | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288038699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285053086 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2019 | ||||||||
| LastUpdateDate: | 05/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.