Provider Demographics
NPI:1225193592
Name:AVINGER, KATHERINE ANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ANNE
Last Name:AVINGER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:AVINGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD, PC
Mailing Address - Street 1:485 HUNTINGTON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-1861
Mailing Address - Country:US
Mailing Address - Phone:706-546-8440
Mailing Address - Fax:706-546-8456
Practice Address - Street 1:485 HUNTINGTON RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-1861
Practice Address - Country:US
Practice Address - Phone:706-546-8440
Practice Address - Fax:706-546-8456
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003056103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1790993814OtherTYPE II NPI