Provider Demographics
NPI:1184303349
Name:COE, KATHRYN CULVERSON (LPC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:CULVERSON
Last Name:COE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:CULVERSON
Other - Last Name:COE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:102 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39817-3602
Mailing Address - Country:US
Mailing Address - Phone:229-416-4737
Mailing Address - Fax:229-416-4738
Practice Address - Street 1:102 N BROAD ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39817-3602
Practice Address - Country:US
Practice Address - Phone:229-416-4737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014037101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional