MEDICARE: CATHERINE FORD LCMHC, LCAS

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	101YP2500X	Professional Counselor	14115	NC
2	101YP2500X	Professional Counselor
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1518420884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE FORD LCMHC, LCAS

Provider Business Mailing Address
First Line	:	PO BOX 11288
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28220-1288
Country	:	US
Telephone Number	:	704-258-1432
Fax Number	:

Provider Business Practice Location Address
First Line	:	4117 PARK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-2214
Country	:	US
Telephone Number	:	704-993-6808
Fax Number	:

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

Provider Enumeration Date	:	04/12/2019
Last Update Date	:	04/23/2026

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