Provider Demographics
NPI:1528673688
Name:AVERY, JOHN PATRICK (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
Last Name:AVERY
Suffix:
Gender:M
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 COLD STREAM CT APT 304
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-0316
Mailing Address - Country:US
Mailing Address - Phone:828-243-2269
Mailing Address - Fax:
Practice Address - Street 1:165 COOLRIDGE ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-2767
Practice Address - Country:US
Practice Address - Phone:828-694-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0150061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty