1689395170 NPI number — MRS. KATELYN HARWELL STROTT LCMHCA

Table of content: MRS. KATELYN HARWELL STROTT LCMHCA (NPI 1689395170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689395170 NPI number — MRS. KATELYN HARWELL STROTT LCMHCA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STROTT
Provider First Name:
KATELYN
Provider Middle Name:
HARWELL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCMHCA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689395170
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3509 WINDBLUFF DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28277-9875
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-902-8900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6302 FAIRVIEW RD STE 310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28210-3273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-584-9897
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/05/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  A17908 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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