Individual
JUDITH TART KETTNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC MS LMFT
Contact information
Practice address
200 VALENCIA DR, SUITE 109, JACKSONVILLE, NC 28546-7356
(910) 346-9000
(910) 355-0672
Mailing address
200 VALENCIA DR, SUITE 109, JACKSONVILLE, NC 28546-7356
(910) 346-9000
(910) 355-0672
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
NC LPC 3778
NC
106H00000X
Marriage & Family Therapist
Primary
NC LMFT 516
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
131CH
BLUE CROSS BLUE SHIELD
—
Enumeration date
12/01/2005
Last updated
06/04/2012
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