Provider Demographics
NPI:1396243473
Name:AFUOLA, KATHERINE ANN (MS,LMHC,MHP,NCC,SUDP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:AFUOLA
Suffix:
Gender:F
Credentials:MS,LMHC,MHP,NCC,SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2394
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632
Mailing Address - Country:US
Mailing Address - Phone:360-200-5419
Mailing Address - Fax:360-200-6736
Practice Address - Street 1:1126 S. GOLD STREET
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531
Practice Address - Country:US
Practice Address - Phone:360-807-4929
Practice Address - Fax:360-807-4160
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60195249101YA0400X
WACP60851768101YA0400X
WALH61256941101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2140261Medicaid