Provider Demographics
NPI:1477268613
Name:POARCH, MARY KATHERINE (LMSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:POARCH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHERINE
Other - Last Name:MALOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:13861 RACEWAY DR APT 312
Mailing Address - Street 2:
Mailing Address - City:NORTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-6551
Mailing Address - Country:US
Mailing Address - Phone:682-558-9938
Mailing Address - Fax:
Practice Address - Street 1:13861 RACEWAY DR APT 312
Practice Address - Street 2:
Practice Address - City:NORTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76262-6551
Practice Address - Country:US
Practice Address - Phone:682-558-9938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68301104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker