Provider Demographics
NPI:1942837125
Name:BOULET, KATHRYN CARACAPPA (LPC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:CARACAPPA
Last Name:BOULET
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1942 DELANO DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-1009
Mailing Address - Country:US
Mailing Address - Phone:404-408-5641
Mailing Address - Fax:
Practice Address - Street 1:1942 DELANO DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-1009
Practice Address - Country:US
Practice Address - Phone:404-408-5641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011413101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health