Provider Demographics
NPI:1619228707
Name:CHISHOLM, KAREN RUTH (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:RUTH
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9108 BUTTERFLY CT
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-9331
Mailing Address - Country:US
Mailing Address - Phone:704-576-9738
Mailing Address - Fax:
Practice Address - Street 1:9108 BUTTERFLY COURT
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-2937
Practice Address - Country:US
Practice Address - Phone:704-576-9738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10022104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker