Healthcare Provider Details

I. General information

NPI: 1255622726
Provider Name (Legal Business Name): KATHY SCHUTZ LCSW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 CROMWELL DR SUITE G
GREENVILLE NC
27858-5436
US

IV. Provider business mailing address

3709 BARTON WAY
GRIMESLAND NC
27837-9159
US

V. Phone/Fax

Practice location:
  • Phone: 252-756-5654
  • Fax:
Mailing address:
  • Phone: 252-714-1755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number200301405
License Number StateNC

VIII. Authorized Official

Name: KATHY SCHUTZ
Title or Position: PRESIDENT/ CEO
Credential: MSW, LCSW, LCAS
Phone: 252-714-1755