Provider Demographics
NPI:1477802379
Name:JUDD, KATHERINE BOTTENUS (LPC-A)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:BOTTENUS
Last Name:JUDD
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4917 OLD TOWNE VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:PFAFFTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27040-9805
Mailing Address - Country:US
Mailing Address - Phone:336-416-0742
Mailing Address - Fax:
Practice Address - Street 1:1301 CAROLINA ST
Practice Address - Street 2:SUITE 114
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1032
Practice Address - Country:US
Practice Address - Phone:336-542-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8596101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional