Individual
MRS. KATHRYN GRIM MATHIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCAS, CSI
Contact information
Practice address
305 E MAIN ST, ELIZABETH CITY, NC 27909-4425
(252) 335-9400
(252) 335-9404
Mailing address
3810 WATERSIDE DR, APT 302, ELIZABETH CITY, NC 27909-9739
(910) 386-8598
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1124
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6111930
—
NC
Enumeration date
02/11/2007
Last updated
09/24/2012
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