Provider Demographics
NPI:1477928620
Name:OKONIEWSKI, KATHERINE CHARLOTTE (MED)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CHARLOTTE
Last Name:OKONIEWSKI
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:CHARLOTTE
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:504 OAK TREE DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-4071
Mailing Address - Country:US
Mailing Address - Phone:919-923-6424
Mailing Address - Fax:
Practice Address - Street 1:5501 FORTUNES RIDGE DR
Practice Address - Street 2:SUITE H
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6102
Practice Address - Country:US
Practice Address - Phone:919-923-6424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-13
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4881103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool