Kettner, Judith Tart

Kettner, Judith Tart is an sole proprietor health care provider with primary practice located at 200 Valencia Dr Suite 109, Jacksonville NC 28546-7356. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Marriage & Family Therapist. Behavioral Health & Social Service Providers / Marriage & Family Therapist is her primary health care specialty. Kettner, Judith Tart can be contacted via phone (910) 346-9000.

Contact Information

Primary practice address
200 Valencia Dr Suite 109 Jacksonville NC 28546-7356
Phone: (910) 346-9000
Fax: (910) 355-0672
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X NC LPC 3778 North Carolina
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X NC LMFT 516 North Carolina

Profile Details

NPI number 1982688180
LBN Legal business name Kettner, Judith Tart
Credentials LPC MS LMFT
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 1st, 2005
Last updated Jun 4th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1982688180 NPPES
Other 131CH BLUE CROSS BLUE SHIELD

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