Provider Demographics
NPI:1417763541
Name:PAUL, KATHLEEN MARY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARY
Last Name:PAUL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:KATIE
Other - Middle Name:MARY
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2607 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-6164
Mailing Address - Country:US
Mailing Address - Phone:252-916-3276
Mailing Address - Fax:
Practice Address - Street 1:2607 SURREY LN
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-6164
Practice Address - Country:US
Practice Address - Phone:252-916-3276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0174671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical