Provider Demographics
NPI:1821727116
Name:WOGATZKE, KATY LYNN (LCMHC)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:LYNN
Last Name:WOGATZKE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 W 4TH ST STE 101B
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2582
Mailing Address - Country:US
Mailing Address - Phone:336-447-6021
Mailing Address - Fax:336-447-6021
Practice Address - Street 1:942 W 4TH ST STE 101B
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2582
Practice Address - Country:US
Practice Address - Phone:336-447-6021
Practice Address - Fax:336-447-6021
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17788101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health