Provider Demographics
NPI:1629791579
Name:KC SOCIAL THERAPY, LLC
Entity Type:Organization
Organization Name:KC SOCIAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHARINE
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:CASE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-716-1838
Mailing Address - Street 1:12324 LOCHNESS CT
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-6914
Mailing Address - Country:US
Mailing Address - Phone:734-716-1838
Mailing Address - Fax:
Practice Address - Street 1:12324 LOCHNESS CT
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-6914
Practice Address - Country:US
Practice Address - Phone:734-716-1838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty