Provider Demographics
NPI:1336688480
Name:FREDERICK, KATHERINE (LCISW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:LCISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9130 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SEMMES
Mailing Address - State:AL
Mailing Address - Zip Code:36575-5322
Mailing Address - Country:US
Mailing Address - Phone:251-222-1948
Mailing Address - Fax:
Practice Address - Street 1:9130 PARK AVE
Practice Address - Street 2:
Practice Address - City:SEMMES
Practice Address - State:AL
Practice Address - Zip Code:36575-5322
Practice Address - Country:US
Practice Address - Phone:251-222-1948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1328C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical