Provider Demographics
NPI:1447940051
Name:BLYTHE, KATIE LASHANDA (LCSWA)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LASHANDA
Last Name:BLYTHE
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134-0062
Mailing Address - Country:US
Mailing Address - Phone:980-228-9751
Mailing Address - Fax:
Practice Address - Street 1:1905 J N PEASE PL STE 103
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4509
Practice Address - Country:US
Practice Address - Phone:980-228-9751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0188411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical