Provider Demographics
NPI:1104510619
Name:AUTREY, ISABELLA PETERSON (LCHMCA)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:PETERSON
Last Name:AUTREY
Suffix:
Gender:F
Credentials:LCHMCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2888 DOUBLE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:GREEN MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28740-6145
Mailing Address - Country:US
Mailing Address - Phone:828-467-2466
Mailing Address - Fax:
Practice Address - Street 1:1293 HENDERSONVILLE RD STE 23
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1956
Practice Address - Country:US
Practice Address - Phone:828-692-6383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18791101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health