Provider Demographics
NPI:1982034567
Name:MEZWICKI, KATHLEEN KELLY (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:KELLY
Last Name:MEZWICKI
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 1:501 BILLINGSLEY RD
Mailing Address - Street 2:BEHAVIORAL HEALTH CENTER CMC RANDOLPH
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1009
Mailing Address - Country:US
Mailing Address - Phone:704-358-2710
Mailing Address - Fax:704-358-2938
Practice Address - Street 1:501 BILLINGSLEY ROAD
Practice Address - Street 2:BEHAVIORAL HEALTH CENTER CMC RANDOLPH
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1009
Practice Address - Country:US
Practice Address - Phone:704-358-2700
Practice Address - Fax:704-358-2716
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0081451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical