Basic Information
| Provider Information | |||||||||
| NPI: | 1881934032 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARREN | ||||||||
| FirstName: | KATHRYN | ||||||||
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| Credential: | LCAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 713 S MARSHALL ST | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271015808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367227266 | ||||||||
| FaxNumber: | 3362010538 | ||||||||
| Practice Location | |||||||||
| Address1: | 379 NEW MARKET BLVD STE 1 | ||||||||
| Address2: | |||||||||
| City: | BOONE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286073765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367227266 | ||||||||
| FaxNumber: | 3362010538 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2013 | ||||||||
| LastUpdateDate: | 01/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 2302 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.