Provider Demographics
NPI:1225160377
Name:KALLENBACH, MARY STEWART SCHWEDER (LCMHCS)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:STEWART SCHWEDER
Last Name:KALLENBACH
Suffix:
Gender:
Credentials:LCMHCS
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:STEWART
Other - Last Name:SCHWEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2419 SILVER CREEK RD P.O. BOX 93
Mailing Address - Street 2:
Mailing Address - City:MILL SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:28756-0093
Mailing Address - Country:US
Mailing Address - Phone:828-388-0779
Mailing Address - Fax:828-894-7111
Practice Address - Street 1:2419 SILVER CREEK RD
Practice Address - Street 2:
Practice Address - City:MILL SPRING
Practice Address - State:NC
Practice Address - Zip Code:28756-0093
Practice Address - Country:US
Practice Address - Phone:828-388-0779
Practice Address - Fax:828-894-7111
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC53220101YM0800X
NC3220101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102993Medicaid