Provider Demographics
NPI:1932124880
Name:LAFAVE, CATHLEEN (PHD)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:
Last Name:LAFAVE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3863 SHAKESPEARE DR
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-9320
Mailing Address - Country:US
Mailing Address - Phone:828-326-3809
Mailing Address - Fax:
Practice Address - Street 1:1120 FAIRGROVE CHURCH RD
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-9630
Practice Address - Country:US
Practice Address - Phone:828-326-3809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2331103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000585Medicaid
NC0438UOtherNC BCBS
NC2819779CMedicare Oscar/Certification
NC0438UOtherNC BCBS