Provider Demographics
NPI:1164668521
Name:PARDOLL, MINDY ERIN (MINDY PARDOLL)
Entity type:Individual
Prefix:DR
First Name:MINDY
Middle Name:ERIN
Last Name:PARDOLL
Suffix:
Gender:F
Credentials:MINDY PARDOLL
Other - Prefix:DR
Other - First Name:MINDY
Other - Middle Name:ERIN
Other - Last Name:PARDOLL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MINDY PARDOLL
Mailing Address - Street 1:12 S LEXINGTON AVE UNIT 307
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-3323
Mailing Address - Country:US
Mailing Address - Phone:305-519-7455
Mailing Address - Fax:
Practice Address - Street 1:12 S LEXINGTON AVE UNIT 307
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3323
Practice Address - Country:US
Practice Address - Phone:305-519-7455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3687103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent