Provider Demographics
NPI:1578032843
Name:GROSS, KATHERINE (LPC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 TOUHEY BLVD UNIT B
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON AFB
Mailing Address - State:SC
Mailing Address - Zip Code:29404-2157
Mailing Address - Country:US
Mailing Address - Phone:330-807-7562
Mailing Address - Fax:
Practice Address - Street 1:1495 REMOUNT RD STE 3A
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-3320
Practice Address - Country:US
Practice Address - Phone:843-882-6880
Practice Address - Fax:843-892-0394
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6644101YM0800X
SC7211101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC2113Medicaid