Provider Demographics
NPI:1588821680
Name:TANDON, KATHERYN JOY (MA LPC)
Entity Type:Individual
Prefix:
First Name:KATHERYN
Middle Name:JOY
Last Name:TANDON
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:KATHERYN
Other - Middle Name:JOY
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA LPC
Mailing Address - Street 1:2525 RAEFORD ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305
Mailing Address - Country:US
Mailing Address - Phone:910-438-0947
Mailing Address - Fax:910-438-0906
Practice Address - Street 1:2525 RAEFORD RD
Practice Address - Street 2:SUITE C
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5091
Practice Address - Country:US
Practice Address - Phone:910-438-0947
Practice Address - Fax:910-438-0906
Is Sole Proprietor?:No
Enumeration Date:2008-05-18
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5453101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional