Provider Demographics
NPI:1902610736
Name:VAN LAAR, KATHERYN (LPC)
Entity type:Individual
Prefix:
First Name:KATHERYN
Middle Name:
Last Name:VAN LAAR
Suffix:
Gender:
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:PO BOX 933
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-0018
Mailing Address - Country:US
Mailing Address - Phone:706-338-6607
Mailing Address - Fax:
Practice Address - Street 1:240 OLD EPPS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2858
Practice Address - Country:US
Practice Address - Phone:706-389-0880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC015363101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health