Provider Demographics
NPI:1144266073
Name:KOLLSTEDT, ROSEMARY (LCSW)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:KOLLSTEDT
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:PO BOX 2822
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28680-2822
Mailing Address - Country:US
Mailing Address - Phone:828-437-3174
Mailing Address - Fax:828-437-3179
Practice Address - Street 1:327 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-6122
Practice Address - Country:US
Practice Address - Phone:828-695-5900
Practice Address - Fax:828-695-4256
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0007191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC261420796OtherTAX ID
NC6002629Medicaid
NC50033OtherBCBS
NC2879763AMedicare ID - Type UnspecifiedMEDICARE