Provider Demographics
NPI:1073542833
Name:DUDLEY, KATHERINE DENISE (LPCC)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:DENISE
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:RABOLD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2551 COORS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:750 MORRIS RD SE
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-5242
Practice Address - Country:US
Practice Address - Phone:505-866-2318
Practice Address - Fax:505-887-9579
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0092361101YM0800X
NM119801101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health