Provider Demographics
NPI:1992906028
Name:OLSON, KATHERINE BUTLER (MED)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:BUTLER
Last Name:OLSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STUDENT WELLNESS CENTER 614 HOWARD ST
Mailing Address - Street 2:P O BOX 32130
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28608-2130
Mailing Address - Country:US
Mailing Address - Phone:828-262-3148
Mailing Address - Fax:
Practice Address - Street 1:STUDENT WELLNESS CTR
Practice Address - Street 2:614 HOWARD STREET
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28608-2130
Practice Address - Country:US
Practice Address - Phone:828-262-3148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3026101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health