Provider Demographics
NPI:1720277023
Name:FREE, KATHLEEN D (PHD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:D
Last Name:FREE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 RIVER CIRCLE
Mailing Address - Street 2:
Mailing Address - City:WINGINA
Mailing Address - State:VA
Mailing Address - Zip Code:24599
Mailing Address - Country:US
Mailing Address - Phone:434-979-1902
Mailing Address - Fax:434-979-0670
Practice Address - Street 1:295 RIVER CIRCLE
Practice Address - Street 2:
Practice Address - City:WINGINA
Practice Address - State:VA
Practice Address - Zip Code:24599
Practice Address - Country:US
Practice Address - Phone:434-979-1902
Practice Address - Fax:434-979-0670
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000244103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist