Provider Demographics
NPI:1518317577
Name:WAUGH, KATHLEEN BIBLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:BIBLE
Last Name:WAUGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4604 CAPE KURE CT
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-1119
Mailing Address - Country:US
Mailing Address - Phone:770-598-3158
Mailing Address - Fax:
Practice Address - Street 1:4604 CAPE KURE CT
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-1119
Practice Address - Country:US
Practice Address - Phone:770-598-3158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW005082101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health