Matthew Gannon
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Burnsville, NC
NPI 1194133090 · NPPES record last updated Jul 24, 2014
Key facts
- NPI
- 1194133090
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- LCAS-20711 (NC)
- Practice address
- 72 Blue Ridge LN
Burnsville, NC 28714-7270 - Phone
- (828) 682-2111
- Fax
- (828) 682-9323
- NPI assigned
- Jul 24, 2014
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCAS-20711 | NC | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LCAS-20711 | NC | Yes |
Addresses
Primary practice location
72 Blue Ridge LN
Burnsville, NC 28714-7270
Mailing address
6 S Bear Creek Rd
Asheville, NC 28806-1502
Other providers in Burnsville, NC
- Families Together, Inc.
- Paul M Feldman
- Genevieve Fonju
- Ashley G Fox
- Tabitha Silvers Fox
- Maddison Garland
- Tabbatha L Garland
- Frances Assael Giardina
- Sara Gibbs
- Jennifer Ann Givens
All providers in Burnsville, NC · Addiction (Substance Use Disorder) Counselor in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.