Provider Demographics
NPI:1063149813
Name:EVIDENCE-BASED PSYCHOTHERAPY OF WESTERN NORTH CAROLINA, PLLC
Entity type:Organization
Organization Name:EVIDENCE-BASED PSYCHOTHERAPY OF WESTERN NORTH CAROLINA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:WILLETT
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:828-248-0738
Mailing Address - Street 1:65 MERRIMON AVE # 1097
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2322
Mailing Address - Country:US
Mailing Address - Phone:828-248-0738
Mailing Address - Fax:
Practice Address - Street 1:137 ARTHUR RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-1630
Practice Address - Country:US
Practice Address - Phone:828-248-0738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health