Provider Demographics
NPI:1891749545
Name:ATCHISON, CATHERINE LYNNE (LCSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:LYNNE
Last Name:ATCHISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 ZINFANDEL PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2744
Mailing Address - Country:US
Mailing Address - Phone:919-846-3455
Mailing Address - Fax:919-846-7748
Practice Address - Street 1:2301 STONEHENGE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4379
Practice Address - Country:US
Practice Address - Phone:919-846-3455
Practice Address - Fax:919-846-7748
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0035511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2879929Medicare ID - Type UnspecifiedMEDICARE PART B