Provider Demographics
NPI:1083684070
Name:MANSFIELD, KATHY DODGE (LPC LCAS CCS)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:DODGE
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:LPC LCAS CCS
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:DODGE
Other - Last Name:BECKWITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC LCAS CCS
Mailing Address - Street 1:2807 NEUSE BLVD
Mailing Address - Street 2:STE 5
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2815
Mailing Address - Country:US
Mailing Address - Phone:252-636-0112
Mailing Address - Fax:252-634-9778
Practice Address - Street 1:2807 NEUSE BLVD
Practice Address - Street 2:STE 5
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2815
Practice Address - Country:US
Practice Address - Phone:252-636-0112
Practice Address - Fax:252-634-9778
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC1030101Y00000X
NCLCAS28101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14309OtherBCBS
NC304557OtherMHN
NC1572OtherCBHA
NC161958OtherVALUE OPTIONS
NC6102019Medicaid