Provider Demographics
NPI:1104369800
Name:CARVER, KATHERINE ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE
Last Name:CARVER
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 1:1040 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-8807
Mailing Address - Country:US
Mailing Address - Phone:984-243-7652
Mailing Address - Fax:
Practice Address - Street 1:1415 BROAD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3534
Practice Address - Country:US
Practice Address - Phone:984-243-7652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0116741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical