Provider Demographics
NPI:1316373715
Name:SOUTHARD, KATHY (LCSW)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:
Last Name:SOUTHARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KATHYLENE
Other - Middle Name:CASTILLO
Other - Last Name:SOUTHARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2232 IVY DR APT 1
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-1942
Mailing Address - Country:US
Mailing Address - Phone:808-892-9108
Mailing Address - Fax:
Practice Address - Street 1:1600 CALIFORNIA DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687
Practice Address - Country:US
Practice Address - Phone:707-448-6841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1188391041C0700X
HIHI-42711041C0700X
CA876771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical