Provider Demographics
NPI:1487082525
Name:HAWK RIDGE THERAPEUTIC CENTER
Entity type:Organization
Organization Name:HAWK RIDGE THERAPEUTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:KRIZEK
Authorized Official - Suffix:
Authorized Official - Credentials:LMBT
Authorized Official - Phone:828-277-7672
Mailing Address - Street 1:1998 HENDERSONVILLE RD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2349
Mailing Address - Country:US
Mailing Address - Phone:828-277-7672
Mailing Address - Fax:828-687-8890
Practice Address - Street 1:1998 HENDERSONVILLE RD STE 13
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2192
Practice Address - Country:US
Practice Address - Phone:828-277-7672
Practice Address - Fax:828-687-8890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6304172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6304OtherSTATE LICENSE