Provider Demographics
NPI:1629140827
Name:WHITESIDE, MARY CATHARINE (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHARINE
Last Name:WHITESIDE
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 1:169 MONTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2101
Mailing Address - Country:US
Mailing Address - Phone:828-215-5971
Mailing Address - Fax:828-639-8025
Practice Address - Street 1:29 RAVENSCROFT DR STE 205
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3602
Practice Address - Country:US
Practice Address - Phone:828-252-2501
Practice Address - Fax:828-639-8025
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0043081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13281OtherBCBS
NC6002528Medicaid
NC6002528Medicaid