Provider Demographics
NPI:1376711507
Name:OLDHAM, KATHERINE MARION (BA PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARION
Last Name:OLDHAM
Suffix:
Gender:F
Credentials:BA PSYCHOLOGY
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:OLDHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3901 BATTLEGROUND AVE APT 199
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7900 TRIAD CENTER DR STE 350
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-9086
Practice Address - Country:US
Practice Address - Phone:336-931-1800
Practice Address - Fax:336-931-1801
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health