Provider Demographics
NPI:1003558412
Name:WATERS, KATHERINE TUCKER (LPC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:TUCKER
Last Name:WATERS
Suffix:
Gender:F
Credentials:LPC, ATR-BC
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, ATR-BC
Mailing Address - Street 1:122 S PASTIME DR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6672
Mailing Address - Country:US
Mailing Address - Phone:703-625-5283
Mailing Address - Fax:
Practice Address - Street 1:KALON CHRISTIAN COUNSELING
Practice Address - Street 2:327 E JACKSON ST, SUITE A
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792
Practice Address - Country:US
Practice Address - Phone:229-234-7447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
17105221700000X
GA012388101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist