Provider Demographics
NPI:1275130783
Name:HERNANDEZ, KATHERINE L
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:L
Last Name:HERNANDEZ
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 1:1829 E FRANKLIN ST STE 800D
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-5868
Mailing Address - Country:US
Mailing Address - Phone:919-704-8449
Mailing Address - Fax:919-704-8617
Practice Address - Street 1:1829 E FRANKLIN ST STE 800D
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-5868
Practice Address - Country:US
Practice Address - Phone:919-704-8449
Practice Address - Fax:919-704-8617
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0152451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC15245Medicaid