Basic Information
Provider Information | |||||||||
NPI: | 1740386481 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GUICHENEY | ||||||||
FirstName: | MARY | ||||||||
MiddleName: | CATHARINE | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WHITE | ||||||||
OtherFirstName: | MARY | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 583 J R PATE ROAD | ||||||||
Address2: |   | ||||||||
City: | BURNSVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 28714 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8033254388 | ||||||||
FaxNumber: | 7043310859 | ||||||||
Practice Location | |||||||||
Address1: | 129 SKYVIEW CIR. | ||||||||
Address2: | RHA BEHAVIORAL HEALTH | ||||||||
City: | SPRUCE PINE | ||||||||
State: | NC | ||||||||
PostalCode: | 28777 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8287650894 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/16/2006 | ||||||||
LastUpdateDate: | 12/07/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/07/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X |   |   | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
ID | Type | State | Issuer | Description | 15088 | 01 | NC | PROVIDER NUMBER | OTHER |