Provider Demographics
NPI:1124479860
Name:DOUBLE, KATELIN (MA)
Entity type:Individual
Prefix:
First Name:KATELIN
Middle Name:
Last Name:DOUBLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 ZILLICOA ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-1079
Mailing Address - Country:US
Mailing Address - Phone:828-254-9494
Mailing Address - Fax:828-250-0890
Practice Address - Street 1:311 WINSTON ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1519
Practice Address - Country:US
Practice Address - Phone:213-893-1960
Practice Address - Fax:213-229-9061
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94022057101YM0800X
NC103311103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health