Provider Demographics
NPI:1972288637
Name:MONTGOMERY, KATHRYN ANN (LCMHCA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12317 HAYMARKET RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-9205
Mailing Address - Country:US
Mailing Address - Phone:704-609-2452
Mailing Address - Fax:
Practice Address - Street 1:6060 PIEDMONT ROW DR S STE 120
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28287-2801
Practice Address - Country:US
Practice Address - Phone:704-552-0116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health