Provider Demographics
NPI:1053527689
Name:HEROLD, KATHLEEN NMI (MED, LPC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:NMI
Last Name:HEROLD
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 KING EDWARD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5604
Mailing Address - Country:US
Mailing Address - Phone:843-276-0694
Mailing Address - Fax:
Practice Address - Street 1:2313 KING EDWARD DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5604
Practice Address - Country:US
Practice Address - Phone:843-276-0694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1629101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional