Provider Demographics
NPI:1134532484
Name:ARCHWAY COUNSELING
Entity type:Organization
Organization Name:ARCHWAY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZALESKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-475-1804
Mailing Address - Street 1:PO BOX 2864
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28680-2864
Mailing Address - Country:US
Mailing Address - Phone:828-475-1804
Mailing Address - Fax:828-475-4143
Practice Address - Street 1:222 W UNION ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3787
Practice Address - Country:US
Practice Address - Phone:828-475-1804
Practice Address - Fax:828-475-1804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS 380251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111754Medicaid