Healthcare Provider Details

I. General information

NPI: 1497007074
Provider Name (Legal Business Name): KATHERINE ANDREA MARTIN LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 S GREEN ST SUITE300
MORGANTON NC
28655-3517
US

IV. Provider business mailing address

PO BOX 1536
MORGANTON NC
28680-1536
US

V. Phone/Fax

Practice location:
  • Phone: 828-437-3000
  • Fax: 828-437-4999
Mailing address:
  • Phone: 828-437-3000
  • Fax: 828-437-4999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP007661
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierP007661
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerLICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: