Provider Demographics
NPI:1932612330
Name:STINSON, KATHERINE (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:STINSON
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:MRS
Other - First Name:KALLE
Other - Middle Name:
Other - Last Name:STINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1080 PARK WEST DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-1399
Mailing Address - Country:US
Mailing Address - Phone:704-650-5545
Mailing Address - Fax:
Practice Address - Street 1:1100 S MINT ST STE 207
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4049
Practice Address - Country:US
Practice Address - Phone:704-650-5545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13276101YM0800X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional