Provider Demographics
NPI:1750687877
Name:DINE, KATHLEEN R (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:R
Last Name:DINE
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:DINE
Other - Last Name:DINE YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:330 TABERNACLE RD
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-2536
Mailing Address - Country:US
Mailing Address - Phone:502-438-0506
Mailing Address - Fax:888-972-1943
Practice Address - Street 1:330 TABERNACLE RD
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-2536
Practice Address - Country:US
Practice Address - Phone:502-438-0506
Practice Address - Fax:888-972-1943
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1125103TC0700X
IN20041479A103TC0700X
KY130426103TC0700X
NC6291103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical