Provider Demographics
NPI:1750925640
Name:DEANS, KATHLEEN (MED, APC, NCC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:DEANS
Suffix:
Gender:F
Credentials:MED, APC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 HARDEN HILL RD APT 101
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-2496
Mailing Address - Country:US
Mailing Address - Phone:706-614-3792
Mailing Address - Fax:
Practice Address - Street 1:1622 MARS HILL RD STE A
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4893
Practice Address - Country:US
Practice Address - Phone:706-310-9046
Practice Address - Fax:706-310-9076
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006491101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor