Provider Demographics
NPI:1831315167
Name:MUNRO, KATHY LOUISE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:LOUISE
Last Name:MUNRO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GLEN MEADOWS CIR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31523-1574
Mailing Address - Country:US
Mailing Address - Phone:912-358-2344
Mailing Address - Fax:
Practice Address - Street 1:1610 NEWCASTLE ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-6846
Practice Address - Country:US
Practice Address - Phone:912-358-2344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0026431041C0700X
GACSW0054761041C0700X
NCC0063641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003222232AMedicaid