Provider Demographics
NPI:1073859799
Name:SAIN, KATHRYN (MA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:SAIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 EAST BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5772
Mailing Address - Country:US
Mailing Address - Phone:704-376-5561
Mailing Address - Fax:
Practice Address - Street 1:1018 EAST BLVD STE 3
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5772
Practice Address - Country:US
Practice Address - Phone:704-376-5561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0954103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical