Provider Demographics
NPI:1275741282
Name:FREDERICK, CATHERINE C (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:C
Last Name:FREDERICK
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 1:2444 COMMERCE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7560
Mailing Address - Country:US
Mailing Address - Phone:800-604-1655
Mailing Address - Fax:910-346-2393
Practice Address - Street 1:2444 COMMERCE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7560
Practice Address - Country:US
Practice Address - Phone:800-604-1655
Practice Address - Fax:910-346-2393
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0017301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003230Medicaid
NC33936OtherBCBS