Healthcare Provider Details

I. General information

NPI: 1205818424
Provider Name (Legal Business Name): CATAWBA COUNSELING ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GLENWAY ST SUITE B
BELMONT NC
28012-3114
US

IV. Provider business mailing address

100 GLENWAY ST SUITE B
BELMONT NC
28012-3114
US

V. Phone/Fax

Practice location:
  • Phone: 704-829-2005
  • Fax:
Mailing address:
  • Phone: 704-829-2005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC003156
License Number StateNC

VIII. Authorized Official

Name: MS. SHARON A. PENDERGAST
Title or Position: MANAGING MEMBER
Credential: M.S.W.
Phone: 704-829-2005