Provider Demographics
NPI:1356413462
Name:UNDERHILL, KATHIE C (LMHC, CEAP)
Entity type:Individual
Prefix:
First Name:KATHIE
Middle Name:C
Last Name:UNDERHILL
Suffix:
Gender:F
Credentials:LMHC, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 DUPONT AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2632
Mailing Address - Country:US
Mailing Address - Phone:904-635-9904
Mailing Address - Fax:904-739-9762
Practice Address - Street 1:1639 BEACH BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-2603
Practice Address - Country:US
Practice Address - Phone:904-635-9904
Practice Address - Fax:904-739-9762
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4130101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health