Healthcare Provider Details

I. General information

NPI: 1528182235
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF THE DIOCESE OF RALEIGH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 W MARKET ST
HERTFORD NC
27944-1150
US

IV. Provider business mailing address

715 NAZARETH ST
RALEIGH NC
27606-2187
US

V. Phone/Fax

Practice location:
  • Phone: 919-821-9750
  • Fax:
Mailing address:
  • Phone: 919-821-9750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN WALSH
Title or Position: EXECUTIVE DIRECTOR
Credential: ACSW
Phone: 919-821-9750