Basic Information
| Provider Information | |||||||||
| NPI: | 1891868402 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SKYLAND BEHAVIORAL HEALTH ASSOCIATES, PA | ||||||||
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| OtherOrganizationName: | SKYLAND BEHAVIORAL MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 OAK PLZ | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288013008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282522501 | ||||||||
| FaxNumber: | 8282522701 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 OAK PLZ | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288013008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282522501 | ||||||||
| FaxNumber: | 8282522701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 08/17/2009 | ||||||||
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| AuthorizedOfficialLastName: | SCOTT | ||||||||
| AuthorizedOfficialFirstName: | HEATHER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8282522501 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 103TC0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 6005102 | 05 | NC | MEDICAID | 890248Q | 05 | NC | MEDICAID |