Provider Demographics
NPI:1336498229
Name:WALDROP, KATHERINE J
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:J
Last Name:WALDROP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:MCPHERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 904
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28459-0904
Mailing Address - Country:US
Mailing Address - Phone:443-604-1109
Mailing Address - Fax:910-304-6770
Practice Address - Street 1:117 HOLDEN BEACH RD SW STE 105
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-1787
Practice Address - Country:US
Practice Address - Phone:910-446-3462
Practice Address - Fax:910-304-6770
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9665101YM0800X
NCS9665101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health