Provider Demographics
NPI:1104303387
Name:LIST, KATHERINE KIRKPATRICK (LICSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:KIRKPATRICK
Last Name:LIST
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ELIZABETH
Other - Last Name:KIRKPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:1111 WAYNE RD NW STE 6
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-3573
Mailing Address - Country:US
Mailing Address - Phone:256-288-3333
Mailing Address - Fax:256-288-3334
Practice Address - Street 1:1910 CHEROKEE AVE SW STE A
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5502
Practice Address - Country:US
Practice Address - Phone:256-775-8824
Practice Address - Fax:256-775-8830
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4161C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical