Provider Demographics
NPI:1487194692
Name:BYRD, KATRICE LACHELLE (MSW, LCSW-A)
Entity Type:Individual
Prefix:MRS
First Name:KATRICE
Middle Name:LACHELLE
Last Name:BYRD
Suffix:
Gender:F
Credentials:MSW, LCSW-A
Other - Prefix:MS
Other - First Name:KATRICE
Other - Middle Name:LACHELLE
Other - Last Name:MCCULLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:844-266-8268
Mailing Address - Fax:
Practice Address - Street 1:335 N CASWELL RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2403
Practice Address - Country:US
Practice Address - Phone:704-384-7980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0110101041C0700X
NCC0119821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical