Provider Demographics
NPI:1356629273
Name:SOUTHEAST CHILD & FAMILY GUIDANCE, PLLC
Entity Type:Organization
Organization Name:SOUTHEAST CHILD & FAMILY GUIDANCE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BREADY
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:704-770-8049
Mailing Address - Street 1:105 WAXHAW PROFESSIONAL PARK DR STE H
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-5018
Mailing Address - Country:US
Mailing Address - Phone:704-770-8049
Mailing Address - Fax:704-256-9968
Practice Address - Street 1:105 WAXHAW PROFESSIONAL PARK DR STE H
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-5018
Practice Address - Country:US
Practice Address - Phone:704-770-8049
Practice Address - Fax:704-256-9968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty