Provider Demographics
NPI:1457900490
Name:HARTLEY, MARY CATHERINE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:HARTLEY
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 1:122 STEED RD
Mailing Address - Street 2:
Mailing Address - City:SEAGROVE
Mailing Address - State:NC
Mailing Address - Zip Code:27341-9549
Mailing Address - Country:US
Mailing Address - Phone:919-609-8691
Mailing Address - Fax:
Practice Address - Street 1:500 E-KU-SUMEE ROAD
Practice Address - Street 2:
Practice Address - City:CANDOR
Practice Address - State:NC
Practice Address - Zip Code:27229
Practice Address - Country:US
Practice Address - Phone:910-974-4183
Practice Address - Fax:910-974-0731
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0079631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical