Basic Information
| Provider Information | |||||||||
| NPI: | 1851760649 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRAIN | ||||||||
| FirstName: | KATHERINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1411 CLARENDON ST | ||||||||
| Address2: | APT A | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277053540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708567525 | ||||||||
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| Practice Location | |||||||||
| Address1: | 508 FULTON ST | ||||||||
| Address2: | 558G/122 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277053875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192860411 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2015 | ||||||||
| LastUpdateDate: | 12/02/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | LG50080986 | DC | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | 20225 | MD | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | C010510 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.