Provider Demographics
NPI:1447722517
Name:CATACALOS, ATHENA (CLC)
Entity type:Individual
Prefix:
First Name:ATHENA
Middle Name:
Last Name:CATACALOS
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9914 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-1714
Mailing Address - Country:US
Mailing Address - Phone:980-999-3305
Mailing Address - Fax:
Practice Address - Street 1:522 POTTS ST
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-8406
Practice Address - Country:US
Practice Address - Phone:980-999-3305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-29
Last Update Date:2018-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC313268174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN