| October Road Inc. | |
|
119 Tunnel Rd Ste B Asheville NC 28805-1800 | |
| (828) 350-1000 | |
| (828) 350-1300 |
| Full Name | October Road Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 119 Tunnel Rd Ste B, Asheville, North Carolina |
| Authorized Official Name and Position | Jason Hendricks (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8149400407 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| October Road Inc. 119 Tunnel Rd Suite D Asheville NC 28805-1869 Ph: (828) 350-1000 | October Road Inc. 119 Tunnel Rd Ste B Asheville NC 28805-1800 Ph: (828) 350-1000 |
| NPI Number | 1144375767 |
|---|---|
| Provider Enumeration Date | 01/24/2007 |
| Last Update Date | 04/10/2024 |
| Certification Date | 04/10/2024 |
| Medicare PECOS PAC ID | 3577611433 |
|---|---|
| Medicare Enrollment ID | O20090501000491 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144375767 | NPI | - | NPPES |
| MHL-011-272 | Other | NC DHSR | |
| 5905845 | Medicaid | NC | |
| 6006159 | Medicaid | NC | |
| 8703016 | Medicaid | NC | |
| 3410004 | Medicaid | NC | |
| 8305312 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | MLH-011-272 (North Carolina) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Annmarie I Russell |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801840830 PECOS PAC ID: 0143127258 Enrollment ID: I20031217000298 |
| Provider Name | John J Stahlman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811006273 PECOS PAC ID: 9436133097 Enrollment ID: I20040614000638 |
| Provider Name | Allen B Gilpin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558335729 PECOS PAC ID: 2163430513 Enrollment ID: I20060328000144 |
| Provider Name | Carol Tourvil |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073652798 PECOS PAC ID: 1850322868 Enrollment ID: I20070827000651 |
| Provider Name | Brady J Schroer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104854686 PECOS PAC ID: 8123913134 Enrollment ID: I20080326000773 |
| Provider Name | Adrianne S Melton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255341954 PECOS PAC ID: 8224186242 Enrollment ID: I20090501000086 |
| Provider Name | Beth K Short |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548580186 PECOS PAC ID: 4284807918 Enrollment ID: I20111025000657 |
| Provider Name | Wade B Hawkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669800306 PECOS PAC ID: 3577791102 Enrollment ID: I20140106000492 |
| Provider Name | Migs Halpern |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467770834 PECOS PAC ID: 8022236058 Enrollment ID: I20140904000585 |
| Provider Name | Veronica L Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326455635 PECOS PAC ID: 7810118882 Enrollment ID: I20141016002622 |
| Provider Name | Cynthia Anne Kinser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700288297 PECOS PAC ID: 6608191259 Enrollment ID: I20150203000594 |
| Provider Name | Colleen Barcus |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104186543 PECOS PAC ID: 7517282684 Enrollment ID: I20150212000370 |
| Provider Name | Louise Yvette Lettre |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477668598 PECOS PAC ID: 0244528016 Enrollment ID: I20161011000968 |
| Provider Name | Kimberly Mcgrady |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083911945 PECOS PAC ID: 3779897707 Enrollment ID: I20161205000655 |
| Provider Name | Michelle M Davidson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629409982 PECOS PAC ID: 2365714409 Enrollment ID: I20170823004114 |
| Provider Name | Shelvey J Wallace |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588900989 PECOS PAC ID: 1153682604 Enrollment ID: I20180227000015 |
| Provider Name | Aryana Calcagni |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669880282 PECOS PAC ID: 6709130941 Enrollment ID: I20181107000827 |
| Provider Name | Lucy F Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669951851 PECOS PAC ID: 5294079398 Enrollment ID: I20181129003558 |
| Provider Name | Jennifer L Bandzwolek |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356881494 PECOS PAC ID: 8921345794 Enrollment ID: I20190201000370 |
| Provider Name | James C Coombs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942863279 PECOS PAC ID: 8729316567 Enrollment ID: I20190819000743 |
| Provider Name | Stephanie Edwards Debruhl |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043627011 PECOS PAC ID: 4981971819 Enrollment ID: I20191025001896 |
| Provider Name | Mary Urban |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538793146 PECOS PAC ID: 2466867833 Enrollment ID: I20210216003290 |
| Provider Name | Alexandria Ehrnsberger Bounds |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679114789 PECOS PAC ID: 4587070917 Enrollment ID: I20210310001536 |
| Provider Name | Terri P Wishon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427256387 PECOS PAC ID: 2365844891 Enrollment ID: I20210707000971 |
| Provider Name | Michelle Lafferty |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578987954 PECOS PAC ID: 5890190805 Enrollment ID: I20210827002956 |
| Provider Name | Rachel Anne Fowler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093472722 PECOS PAC ID: 6406248814 Enrollment ID: I20220115000160 |
| Provider Name | Heather K Bryan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588235642 PECOS PAC ID: 9436547254 Enrollment ID: I20230222000682 |
| Provider Name | Alicia M Davis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538786587 PECOS PAC ID: 7810352820 Enrollment ID: I20230426002565 |
| Provider Name | Travis W Richardson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700485430 PECOS PAC ID: 5799142949 Enrollment ID: I20230605000724 |
| Provider Name | James C Revels |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871655852 PECOS PAC ID: 8921444183 Enrollment ID: I20240311000271 |
| Provider Name | Mary E Deane |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336639574 PECOS PAC ID: 8123467412 Enrollment ID: I20240419000433 |
| Provider Name | Heather C Frazier |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750971081 PECOS PAC ID: 8224570965 Enrollment ID: I20240610000534 |
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