Provider Demographics
NPI:1922637602
Name:ANDERSON, KATHLEEN MARIE (LMFTA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 TROLLINGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HAW RIVER
Mailing Address - State:NC
Mailing Address - Zip Code:27258-8749
Mailing Address - Country:US
Mailing Address - Phone:607-237-3423
Mailing Address - Fax:
Practice Address - Street 1:359 TROLLINGWOOD RD
Practice Address - Street 2:
Practice Address - City:HAW RIVER
Practice Address - State:NC
Practice Address - Zip Code:27258-8749
Practice Address - Country:US
Practice Address - Phone:607-237-3423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-05
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12105A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist