Provider Demographics
NPI:1033241419
Name:SCHUTZ, KATHY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:
Last Name:SCHUTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 BARTON WAY
Mailing Address - Street 2:
Mailing Address - City:GRIMESLAND
Mailing Address - State:NC
Mailing Address - Zip Code:27837-9159
Mailing Address - Country:US
Mailing Address - Phone:252-714-1755
Mailing Address - Fax:
Practice Address - Street 1:702 CROMWELL DR
Practice Address - Street 2:SUITE G
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5436
Practice Address - Country:US
Practice Address - Phone:252-714-1755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOO53921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106507Medicaid