Provider Demographics
NPI:1932393642
Name:WICK, KATHRYN WEAVER (LMFT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:WEAVER
Last Name:WICK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10327 ROYAL WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3835
Mailing Address - Country:US
Mailing Address - Phone:415-254-2690
Mailing Address - Fax:
Practice Address - Street 1:10327 ROYAL WINCHESTER DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3835
Practice Address - Country:US
Practice Address - Phone:415-254-2690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86623106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist