Provider Demographics
NPI:1164064663
Name:MCFADDEN, KATRINIA DENISE
Entity Type:Individual
Prefix:
First Name:KATRINIA
Middle Name:DENISE
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-5643
Mailing Address - Country:US
Mailing Address - Phone:703-283-1662
Mailing Address - Fax:
Practice Address - Street 1:215 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-2638
Practice Address - Country:US
Practice Address - Phone:803-435-2124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health