MEDICARE: CATHERINE SYDNEY FARMER LCMHCA, LCASA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	28678	NC
2	101YM0800X	Mental Health Counselor	A18084	NC
3	101YP2500X	Professional Counselor	A18084	NC

General Provider Information

NPI Number	:	1194449371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE SYDNEY FARMER LCMHCA, LCASA

Provider Business Mailing Address
First Line	:	615 SHIPYARD BLVD
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412-6431
Country	:	US
Telephone Number	:	910-343-0145
Fax Number	:	910-341-5779

Provider Business Practice Location Address
First Line	:	7910 US HWY 117 S
Second Line	:
City	:	ROCKY POINT
State	:	NC
Zip	:	28457-9431
Country	:	US
Telephone Number	:	910-259-0668
Fax Number	:	910-259-4526

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2022
Last Update Date	:	01/18/2023

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