Provider Demographics
NPI:1740513159
Name:FUENFHAUSEN, KERRIE KARDATZKE (PHD, LCMHC)
Entity type:Individual
Prefix:DR
First Name:KERRIE
Middle Name:KARDATZKE
Last Name:FUENFHAUSEN
Suffix:
Gender:F
Credentials:PHD, LCMHC
Other - Prefix:
Other - First Name:KERRIE
Other - Middle Name:N
Other - Last Name:KARDATZKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2056
Mailing Address - Country:US
Mailing Address - Phone:336-509-5535
Mailing Address - Fax:
Practice Address - Street 1:16 PARK AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2056
Practice Address - Country:US
Practice Address - Phone:336-509-5535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7420101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional