Provider Demographics
NPI:1881910750
Name:GANNON, MARIE TAYLOR (LPC)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:TAYLOR
Last Name:GANNON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:TAYLOR
Other - Last Name:NEMEROV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1293 HENDERSONVILLE RD STE 7
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1955
Mailing Address - Country:US
Mailing Address - Phone:828-482-0356
Mailing Address - Fax:
Practice Address - Street 1:1293 HENDERSONVILLE RD STE 7
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1955
Practice Address - Country:US
Practice Address - Phone:828-482-0356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1537101YA0400X
NC8896101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)