Provider Demographics
NPI:1568622256
Name:DART, KATHLEEN CHRISTINE (LCSW)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:CHRISTINE
Last Name:DART
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PECAN CT
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30683-2325
Mailing Address - Country:US
Mailing Address - Phone:172-859-1655
Mailing Address - Fax:
Practice Address - Street 1:14 PECAN CT
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30683-2325
Practice Address - Country:US
Practice Address - Phone:517-285-9165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010898021041C0700X
GACSW0070531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
12118724OtherCAQH