Provider Demographics
NPI:1306162334
Name:LIST, KATHERINE MENDAT (LPCS)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MENDAT
Last Name:LIST
Suffix:
Gender:F
Credentials:LPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3913 IRON HORSE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-5044
Mailing Address - Country:US
Mailing Address - Phone:843-367-4819
Mailing Address - Fax:
Practice Address - Street 1:1020 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1258
Practice Address - Country:US
Practice Address - Phone:919-551-2312
Practice Address - Fax:919-516-0057
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7867101YM0800X
NCS7876101YM0800X
NCS7867101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health