Provider Demographics
NPI:1407183668
Name:WEBB, KATHRYN RUTH (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:RUTH
Last Name:WEBB
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9504 WATERGATE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-2105
Mailing Address - Country:US
Mailing Address - Phone:704-609-9558
Mailing Address - Fax:
Practice Address - Street 1:9504 WATERGATE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-2105
Practice Address - Country:US
Practice Address - Phone:704-609-9558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0021421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007581Medicaid