Provider Demographics
NPI:1700145042
Name:CATHLEEN KOUVOLO LLC
Entity Type:Organization
Organization Name:CATHLEEN KOUVOLO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:CATHLEEN
Authorized Official - Middle Name:KOUVOLO
Authorized Official - Last Name:WINCEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-614-2675
Mailing Address - Street 1:55 ASHLEY AVE
Mailing Address - Street 2:APARTMENT 21
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1269
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9263 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-7109
Practice Address - Country:US
Practice Address - Phone:843-377-1600
Practice Address - Fax:843-377-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC311512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty