Provider Demographics
NPI:1326323825
Name:NIEZGODA, KATHRYN ELIZABETH (LPC, NCC)
Entity Type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:NIEZGODA
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11763
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-0763
Mailing Address - Country:US
Mailing Address - Phone:757-604-9498
Mailing Address - Fax:
Practice Address - Street 1:1709 COLLEY AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1675
Practice Address - Country:US
Practice Address - Phone:757-604-9498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-15
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005086101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional