Provider Demographics
NPI:1366067381
Name:BOURGOIN, KADIE ANN (LPC)
Entity type:Individual
Prefix:
First Name:KADIE
Middle Name:ANN
Last Name:BOURGOIN
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 1:1817 PICKENS ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2630
Mailing Address - Country:US
Mailing Address - Phone:803-356-0134
Mailing Address - Fax:803-401-5424
Practice Address - Street 1:1817 PICKENS ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2630
Practice Address - Country:US
Practice Address - Phone:803-356-0134
Practice Address - Fax:803-401-5424
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-15
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13044101YM0800X
SC7631101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health