Provider Demographics
NPI:1922502988
Name:DYSON, KATHERINE MONROE (LPC-A)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:MONROE
Last Name:DYSON
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:EILEEN
Other - Last Name:MONROE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-A
Mailing Address - Street 1:1262 WOODSAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HANAHAN
Mailing Address - State:SC
Mailing Address - Zip Code:29410
Mailing Address - Country:US
Mailing Address - Phone:757-645-7002
Mailing Address - Fax:
Practice Address - Street 1:222 WEST COLEMAN BLVD
Practice Address - Street 2:SUITE #107
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:540-523-1883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
SCLPC-A6818101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health