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NPI Code Detail

MEDICARE: KATHERINE MENDAT LIST LPCS

MEDICARE: KATHERINE MENDAT LIST LPCS
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
1101YM0800XMental Health Counselor7867NC
2101YM0800XMental Health CounselorS7876NC
3101YM0800XMental Health CounselorS7867NC

General Provider Information

NPI Number : 1306162334
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE MENDAT LIST LPCS
Provider Business Mailing Address
First Line : 3913 IRON HORSE RD
Second Line :
City : RALEIGH
State : NC
Zip : 27616-5044
Country : US
Telephone Number : 843-367-4819
Fax Number :
Provider Business Practice Location Address
First Line : 1020 WASHINGTON ST
Second Line :
City : RALEIGH
State : NC
Zip : 27605-1258
Country : US
Telephone Number : 919-551-2312
Fax Number : 919-516-0057
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2010
Last Update Date : 10/09/2023

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Directions to “ KATHERINE MENDAT LIST LPCS” Practice Location

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