Provider Demographics
NPI:1003938820
Name:HUNSUCKER, KATHRYN GRAVES (MA,LPC,LCAS,ACS,CCS)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GRAVES
Last Name:HUNSUCKER
Suffix:
Gender:F
Credentials:MA,LPC,LCAS,ACS,CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 BRIDGES ST STE B
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2979
Mailing Address - Country:US
Mailing Address - Phone:252-648-3124
Mailing Address - Fax:
Practice Address - Street 1:3820 BRIDGES ST STE B
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2979
Practice Address - Country:US
Practice Address - Phone:252-648-3124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC758101YA0400X
NC3827101YP2500X
NCMHL-016-034101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102609Medicaid
NC6112363Medicaid