Provider Demographics
NPI:1346789674
Name:JETT, KATHARINE WHEELER (CRC, LPCA)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:WHEELER
Last Name:JETT
Suffix:
Gender:F
Credentials:CRC, LPCA
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:EDWARDS
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:911 BRIDGES ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-3837
Mailing Address - Country:US
Mailing Address - Phone:910-265-0769
Mailing Address - Fax:
Practice Address - Street 1:310 COMMERCE AVE STE B
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2952
Practice Address - Country:US
Practice Address - Phone:252-499-9021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12310101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional