Provider Demographics
NPI:1710252515
Name:HUSEMAN, KATHRYN NICOLE (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:NICOLE
Last Name:HUSEMAN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 PARK AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-2118
Mailing Address - Country:US
Mailing Address - Phone:678-425-9007
Mailing Address - Fax:678-425-9009
Practice Address - Street 1:138 PARK AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-2118
Practice Address - Country:US
Practice Address - Phone:678-425-9007
Practice Address - Fax:678-425-9009
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007388101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional