MEDICARE: CATELYN BRIANNA HARDIN

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	1041C0700X	Clinical Social Worker		NC

General Provider Information

NPI Number	:	1518609692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATELYN BRIANNA HARDIN

Provider Business Mailing Address
First Line	:	110 E CENTRAL ST
Second Line	:
City	:	MAXTON
State	:	NC
Zip	:	28364-1816
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5840 OLD RED SPRINGS RD
Second Line	:
City	:	MAXTON
State	:	NC
Zip	:	28364-8117
Country	:	US
Telephone Number	:	910-813-0634
Fax Number	:

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

Provider Enumeration Date	:	04/10/2022
Last Update Date	:	04/10/2022

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