Provider Demographics
NPI:1083430292
Name:POULIOT, KATHERINE ERWIN
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ERWIN
Last Name:POULIOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1078 LEAH LN SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-2821
Mailing Address - Country:US
Mailing Address - Phone:617-943-6206
Mailing Address - Fax:
Practice Address - Street 1:1078 LEAH LN SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-2821
Practice Address - Country:US
Practice Address - Phone:617-943-6206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health