Provider Demographics
NPI:1619480753
Name:MEARES, CATHERINE DIANNA
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:DIANNA
Last Name:MEARES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:DIANNA
Other - Last Name:STUKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2107 RHODES AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-2735
Mailing Address - Country:US
Mailing Address - Phone:910-616-8453
Mailing Address - Fax:
Practice Address - Street 1:705 S KERR AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8425
Practice Address - Country:US
Practice Address - Phone:910-782-3499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-12
Last Update Date:2017-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician