Provider Demographics
NPI:1891041646
Name:KAPP, MARY KATHERINE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY KATHERINE
Middle Name:
Last Name:KAPP
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 PETREE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4402
Mailing Address - Country:US
Mailing Address - Phone:336-931-1800
Mailing Address - Fax:336-931-1801
Practice Address - Street 1:10 CRISPIN CT STE 203D
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-8205
Practice Address - Country:US
Practice Address - Phone:828-250-3700
Practice Address - Fax:828-250-3701
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NCC0090461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health