Provider Demographics
NPI:1154723278
Name:SERVIAN, KATHLEEN (LPC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SERVIAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 PAW PAW AVE
Mailing Address - Street 2:
Mailing Address - City:RIVESVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26588-9735
Mailing Address - Country:US
Mailing Address - Phone:304-322-0463
Mailing Address - Fax:
Practice Address - Street 1:44 PAW PAW AVE
Practice Address - Street 2:
Practice Address - City:RIVESVILLE
Practice Address - State:WV
Practice Address - Zip Code:26588-9735
Practice Address - Country:US
Practice Address - Phone:304-322-0463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1919101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional