Provider Demographics
NPI:1295247021
Name:TEDESCHI, KATHERINE DUCKETT
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:DUCKETT
Last Name:TEDESCHI
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:ELIZABETH
Other - Last Name:DUCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 CAROLINA POINT PKWY APT 828
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6575
Mailing Address - Country:US
Mailing Address - Phone:864-518-2455
Mailing Address - Fax:
Practice Address - Street 1:405A E 1ST AVE
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3062
Practice Address - Country:US
Practice Address - Phone:864-383-1605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
SC7615101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health