Provider Demographics
NPI:1548390099
Name:STOUTE, KATHY ANN (MA, LPA)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:ANN
Last Name:STOUTE
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 RIVER FRONT PL APT 101
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-7036
Mailing Address - Country:US
Mailing Address - Phone:910-251-6445
Mailing Address - Fax:910-341-4419
Practice Address - Street 1:138 N 4TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4037
Practice Address - Country:US
Practice Address - Phone:910-251-6445
Practice Address - Fax:910-341-4419
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2351103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107242Medicaid