Provider Demographics
NPI:1972807931
Name:MALLOW, KATHLEEN KARR (MS, MED, LPC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:KARR
Last Name:MALLOW
Suffix:
Gender:F
Credentials:MS, MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 UNION CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-7948
Mailing Address - Country:US
Mailing Address - Phone:910-783-6444
Mailing Address - Fax:
Practice Address - Street 1:305 PAGE RD N STE 6
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-4619
Practice Address - Country:US
Practice Address - Phone:910-722-2049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8350101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional