Provider Demographics
NPI:1770899197
Name:WACHTEL, KATIE (MRC, LPC, CRC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:WACHTEL
Suffix:
Gender:F
Credentials:MRC, LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3713 RICHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2111
Mailing Address - Country:US
Mailing Address - Phone:336-288-1484
Mailing Address - Fax:
Practice Address - Street 1:3713 RICHFIELD RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2111
Practice Address - Country:US
Practice Address - Phone:336-288-1484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0900502101YP2500X
NC9978101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional