Provider Demographics
NPI:1437852357
Name:ISHERWOOD, KAITLYN DEANNE (MS, LCMHCA, NCC)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:DEANNE
Last Name:ISHERWOOD
Suffix:
Gender:F
Credentials:MS, LCMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 LEGACY CT APT 42
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-5103
Mailing Address - Country:US
Mailing Address - Phone:704-661-7123
Mailing Address - Fax:
Practice Address - Street 1:1437 MILITARY CUTOFF RD STE 210
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3638
Practice Address - Country:US
Practice Address - Phone:910-240-2489
Practice Address - Fax:910-447-4421
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18553101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor