Provider Demographics
NPI:1891142105
Name:LOVE, KATHLEEN ANNETTE (LICSW ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANNETTE
Last Name:LOVE
Suffix:
Gender:F
Credentials:LICSW ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14322 E ALKI AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-2007
Mailing Address - Country:US
Mailing Address - Phone:509-714-1545
Mailing Address - Fax:
Practice Address - Street 1:2702 N. PERRY
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207
Practice Address - Country:US
Practice Address - Phone:509-714-1545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60025722101YA0400X
WASC603693151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)