Provider Demographics
NPI:1871380303
Name:RWECHUNGURA, KATIE KERSEY (LCMHC-A, NCC)
Entity type:Individual
Prefix:MS
First Name:KATIE
Middle Name:KERSEY
Last Name:RWECHUNGURA
Suffix:
Gender:
Credentials:LCMHC-A, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 JOYNER ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-2404
Mailing Address - Country:US
Mailing Address - Phone:336-430-3085
Mailing Address - Fax:
Practice Address - Street 1:611 JOYNER ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-2404
Practice Address - Country:US
Practice Address - Phone:336-430-3085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21006101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional