Provider Demographics
NPI:1750687877
Name:DINE, KATHLEEN R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:R
Last Name:DINE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:DINE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 CLEMMONS ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:IN
Mailing Address - Zip Code:47243-9659
Mailing Address - Country:US
Mailing Address - Phone:502-438-0506
Mailing Address - Fax:888-972-1943
Practice Address - Street 1:2915 FRANKFORT AVE STE D
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2682
Practice Address - Country:US
Practice Address - Phone:502-438-0506
Practice Address - Fax:888-972-1943
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1125103TC0700X
IN20041479A103TC0700X
NC6291103TC0700X
KY130426103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical