Healthcare Provider Details

I. General information

NPI: 1114764438
Provider Name (Legal Business Name): KATHERINE MARIE CHAPPELL LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 N 4TH ST
WILMINGTON NC
28401-3450
US

IV. Provider business mailing address

925 N 4TH ST
WILMINGTON NC
28401-3450
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-0270
  • Fax: 910-251-1540
Mailing address:
  • Phone: 910-343-0270
  • Fax: 910-251-1540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP020624
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: