Provider Demographics
NPI:1588338925
Name:NEWSOME, MARY KATHERINE (LCMHCA, MA)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:KATHERINE
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:LCMHCA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2922 SAINT MARKS RD APT E
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5621
Mailing Address - Country:US
Mailing Address - Phone:336-971-2816
Mailing Address - Fax:
Practice Address - Street 1:3000 BETHESDA PL STE 301
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3325
Practice Address - Country:US
Practice Address - Phone:336-501-8044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13413101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health