Provider Demographics
NPI:1801028659
Name:GAUGER, KATHRYN ELEANOR (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ELEANOR
Last Name:GAUGER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:ELEANOR
Other - Last Name:BOLSTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA LPC
Mailing Address - Street 1:810 TYVOLA RD
Mailing Address - Street 2:SUITE 126
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217
Mailing Address - Country:US
Mailing Address - Phone:704-566-3410
Mailing Address - Fax:704-537-1226
Practice Address - Street 1:810 TYVOLA RD
Practice Address - Street 2:SUITE 126
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217
Practice Address - Country:US
Practice Address - Phone:704-566-3410
Practice Address - Fax:704-537-1226
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103198Medicaid