Provider Demographics
NPI:1740630102
Name:PAYNE, KATHRYN LEIGH (LPC, CAC)
Entity type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:LEIGH
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LPC, CAC
Other - Prefix:MISS
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, CAC
Mailing Address - Street 1:1323 HAMRIC DR E
Mailing Address - Street 2:SUITE A
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-1996
Mailing Address - Country:US
Mailing Address - Phone:256-453-8089
Mailing Address - Fax:256-403-5183
Practice Address - Street 1:879 S 5TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5115
Practice Address - Country:US
Practice Address - Phone:256-453-8089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3482101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional