Provider Demographics
NPI:1235399932
Name:MAYOU, KATHLEEN (MS)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:MAYOU
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ALFALFA DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01560-1241
Mailing Address - Country:US
Mailing Address - Phone:860-329-7449
Mailing Address - Fax:
Practice Address - Street 1:817 CULPEPER ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-3316
Practice Address - Country:US
Practice Address - Phone:540-222-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YP2500X
VA0701010548101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)