Provider Demographics
NPI:1982490140
Name:CARBOCCI, KATHERINE (LCMCHA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:CARBOCCI
Suffix:
Gender:
Credentials:LCMCHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 BACK BAY RD
Mailing Address - Street 2:
Mailing Address - City:MANTEO
Mailing Address - State:NC
Mailing Address - Zip Code:27954-8015
Mailing Address - Country:US
Mailing Address - Phone:252-619-1154
Mailing Address - Fax:
Practice Address - Street 1:3901 BARRETT DR STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6523
Practice Address - Country:US
Practice Address - Phone:919-900-7552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19298101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health