Provider Demographics
NPI:1114176955
Name:ZUIDERVEEN, KURTIS T (LPC)
Entity Type:Individual
Prefix:
First Name:KURTIS
Middle Name:T
Last Name:ZUIDERVEEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 S SHARON AMITY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2865
Mailing Address - Country:US
Mailing Address - Phone:704-365-4545
Mailing Address - Fax:704-365-4412
Practice Address - Street 1:413 S SHARON AMITY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2865
Practice Address - Country:US
Practice Address - Phone:704-365-4545
Practice Address - Fax:704-365-4412
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6732101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional