Provider Demographics
NPI:1891365961
Name:WORTHINGTON, KATRINA NICHOLE (LMHP-R)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:NICHOLE
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:LMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14392 WESTMINISTER LN APT 33
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-3057
Mailing Address - Country:US
Mailing Address - Phone:804-709-8839
Mailing Address - Fax:
Practice Address - Street 1:14392 WESTMINISTER LN APT 33
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-3057
Practice Address - Country:US
Practice Address - Phone:804-709-8839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health