Healthcare Provider Details

I. General information

NPI: 1447773031
Provider Name (Legal Business Name): CATHERINE STOWE CARSTARPHEN D.MIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 08/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5203 SHARON RD
CHARLOTTE NC
28210-4721
US

IV. Provider business mailing address

PO BOX 69
MC ADENVILLE NC
28101-0069
US

V. Phone/Fax

Practice location:
  • Phone: 704-554-9900
  • Fax: 704-554-9956
Mailing address:
  • Phone: 704-460-9684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number110
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: