Provider Demographics
NPI:1831205087
Name:NUNNEMAKER, KATHI ELAINE (LCSW, CAD)
Entity type:Individual
Prefix:MS
First Name:KATHI
Middle Name:ELAINE
Last Name:NUNNEMAKER
Suffix:
Gender:F
Credentials:LCSW, CAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 COUNTY ROAD 22
Mailing Address - Street 2:
Mailing Address - City:PACHUTA
Mailing Address - State:MS
Mailing Address - Zip Code:39347-5043
Mailing Address - Country:US
Mailing Address - Phone:601-727-2213
Mailing Address - Fax:
Practice Address - Street 1:131 COUNTY ROAD 22
Practice Address - Street 2:
Practice Address - City:PACHUTA
Practice Address - State:MS
Practice Address - Zip Code:39347-5043
Practice Address - Country:US
Practice Address - Phone:601-727-2213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2767-C1041C0700X
MSC74011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical