Provider Demographics
NPI:1770508970
Name:HOLLINGSWORTH, KATHRYN J (LPC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:J
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3541 RANDOLPH RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1082
Mailing Address - Country:US
Mailing Address - Phone:704-381-8365
Mailing Address - Fax:704-381-8832
Practice Address - Street 1:3541 RANDOLPH RD
Practice Address - Street 2:SUITE 206
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1082
Practice Address - Country:US
Practice Address - Phone:704-381-8365
Practice Address - Fax:704-381-8832
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4846101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103128Medicaid