Provider Demographics
NPI:1053600833
Name:RICHARD, KATHLEEN MARIE (MS LPC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:RICHARD
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 MCRAE ST
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-3014
Mailing Address - Country:US
Mailing Address - Phone:817-307-2496
Mailing Address - Fax:910-248-6649
Practice Address - Street 1:316 MCRAE ST
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-3014
Practice Address - Country:US
Practice Address - Phone:817-307-2496
Practice Address - Fax:910-248-6649
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65534101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor