Provider Demographics
NPI:1043896913
Name:CATHERINE KABASIA LLC
Entity Type:Organization
Organization Name:CATHERINE KABASIA LLC
Other - Org Name:CATHERINE KABASIA LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:DIMAKATSO
Authorized Official - Last Name:KABASIA-SELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:479-601-7577
Mailing Address - Street 1:19 E MOUNTAIN ST STE 12
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-6067
Mailing Address - Country:US
Mailing Address - Phone:479-601-7577
Mailing Address - Fax:
Practice Address - Street 1:19 E MOUNTAIN ST STE 12
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-6067
Practice Address - Country:US
Practice Address - Phone:479-601-7577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty