Provider Demographics
NPI:1316712896
Name:ALEWINE, KATIE GRACE (LCSW)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:GRACE
Last Name:ALEWINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 124
Mailing Address - Street 2:
Mailing Address - City:HARTWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30643-0124
Mailing Address - Country:US
Mailing Address - Phone:706-491-1422
Mailing Address - Fax:
Practice Address - Street 1:1190 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BOWERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30516-1220
Practice Address - Country:US
Practice Address - Phone:706-491-1422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0086761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical