Provider Demographics
NPI:1700993268
Name:DEAN, KATHERINE A (MED)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:A
Last Name:DEAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 BROCKMORE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-5953
Mailing Address - Country:US
Mailing Address - Phone:864-299-1228
Mailing Address - Fax:
Practice Address - Street 1:405 PETTIGRU ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3114
Practice Address - Country:US
Practice Address - Phone:864-271-3549
Practice Address - Fax:864-271-8282
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3405101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor