Healthcare Provider Details

I. General information

NPI: 1255819645
Provider Name (Legal Business Name): MARTHA SUE QUATTLEBAUM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 BRAGG BLVD STE A
FAYETTEVILLE NC
28303-4141
US

IV. Provider business mailing address

PO BOX 62
FAYETTEVILLE NC
28302-0062
US

V. Phone/Fax

Practice location:
  • Phone: 910-460-3392
  • Fax: 910-218-9182
Mailing address:
  • Phone: 910-460-3392
  • Fax: 910-218-9182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC015041
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: