Provider Demographics
NPI:1790250629
Name:WHITESIDE, KATHY ARLENE (LCSW-A)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:ARLENE
Last Name:WHITESIDE
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FAMILY PRESERVATION SERVICES
Mailing Address - Street 2:1316 D PATTON AVE
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806
Mailing Address - Country:US
Mailing Address - Phone:828-225-3100
Mailing Address - Fax:
Practice Address - Street 1:FAMILY PRESERVATION SERVICES
Practice Address - Street 2:1316 D PATTON AVE
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806
Practice Address - Country:US
Practice Address - Phone:828-225-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0129761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical