Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CSAC-20156 | NC |
NPI | 1003369877 |
---|---|
Provider Name | Matthew Fuenfhausen |
First Address | Asheville, NC 28801-4342 |
Second Address | Hendersonville, NC 28791-2302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2016 |
Last Update Date | 28/07/2016 |