Provider Demographics
NPI:1629366737
Name:BARR, KATHLEEN ROLFS (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ROLFS
Last Name:BARR
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 1:5638 ROCKY TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-3743
Mailing Address - Country:US
Mailing Address - Phone:704-651-2996
Mailing Address - Fax:
Practice Address - Street 1:10801 JOHNSTON RD
Practice Address - Street 2:SUITE 230
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4558
Practice Address - Country:US
Practice Address - Phone:704-651-2996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0041491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical