Provider Demographics
NPI:1326174871
Name:WALSH, KATHLEEN (LPC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 MONROE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7825
Mailing Address - Country:US
Mailing Address - Phone:704-910-2313
Mailing Address - Fax:
Practice Address - Street 1:635 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2376
Practice Address - Country:US
Practice Address - Phone:814-375-6379
Practice Address - Fax:814-375-9320
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001131101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104200Medicaid