Provider Demographics
NPI:1083786610
Name:GRACE, KATHY FRIDAY (MA,LPC)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:FRIDAY
Last Name:GRACE
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ELMSTEAD PL
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-8609
Mailing Address - Country:US
Mailing Address - Phone:919-489-4957
Mailing Address - Fax:
Practice Address - Street 1:7 ELMSTEAD PL
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-8609
Practice Address - Country:US
Practice Address - Phone:919-489-4957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3148101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1306XOtherBCBSNC PROV #