Provider Demographics
NPI:1750933776
Name:DURDEN, KATHRYN (LMFTA)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:DURDEN
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:MRS
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:DURDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6022 BLUE ASH LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-4535
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13420 REESE BLVD W
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7925
Practice Address - Country:US
Practice Address - Phone:704-937-2286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
25279A101YA0400X
NC12159A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12159AOtherLICENSURE NUMBER
NCLCAS-25279OtherSUBSTANCE ABUSE LICENSURE NUMBER