Provider Demographics
NPI:1902643562
Name:WEST, KATHLEEN (PHD, LPCA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:PHD, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3267 KINGSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-9279
Mailing Address - Country:US
Mailing Address - Phone:803-579-4416
Mailing Address - Fax:
Practice Address - Street 1:1620 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1809
Practice Address - Country:US
Practice Address - Phone:803-579-4416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8477101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health