Healthcare Provider Details

I. General information

NPI: 1124963541
Provider Name (Legal Business Name): CATHERINE KOLSTAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 CHERRY ST
NORTH WILKESBORO NC
28659-4229
US

IV. Provider business mailing address

613 CHERRY ST
NORTH WILKESBORO NC
28659-4229
US

V. Phone/Fax

Practice location:
  • Phone: 336-667-1121
  • Fax:
Mailing address:
  • Phone: 336-667-1121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number786634
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: