Provider Demographics
NPI:1598985129
Name:KERSHAW, KATHY TOMBLIN (MA LPC NCC)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:TOMBLIN
Last Name:KERSHAW
Suffix:
Gender:F
Credentials:MA LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SMITH LEVEL RD APT A22
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-2599
Mailing Address - Country:US
Mailing Address - Phone:919-619-5865
Mailing Address - Fax:
Practice Address - Street 1:100 EUROPA DR
Practice Address - Street 2:SUITE 490
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-2357
Practice Address - Country:US
Practice Address - Phone:919-913-4134
Practice Address - Fax:919-913-4004
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4072101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103086Medicaid