Basic Information
| Provider Information | |||||||||
| NPI: | 1013547918 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GITTARD | ||||||||
| FirstName: | ECATERINA | ||||||||
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| Credential: | MSW, LCSWA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 340 NATALIE DR | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271042448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046542706 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 WALTER REED DR | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274031128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368329700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2020 | ||||||||
| LastUpdateDate: | 01/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | P009850 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.