Provider Demographics
NPI:1306003116
Name:VALENTINE-BLOUNT, KATHERINE N
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:N
Last Name:VALENTINE-BLOUNT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 1ST ST E
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-3104
Mailing Address - Country:US
Mailing Address - Phone:252-287-0213
Mailing Address - Fax:252-287-0213
Practice Address - Street 1:228 MAIN ST E
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3418
Practice Address - Country:US
Practice Address - Phone:252-287-0213
Practice Address - Fax:252-287-0213
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 101Y00000X, 101YA0400X, 101YM0800X, 101YP1600X, 1041C0700X, 175T00000X, 291U00000X, 320900000X, 171W00000X
NC307575163WA2000X, 163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No175T00000XOther Service ProvidersPeer Specialist
No291U00000XLaboratoriesClinical Medical Laboratory
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1306003116Medicaid