Healthcare Provider Details

I. General information

NPI: 1366517492
Provider Name (Legal Business Name): KATHY WILLCUTT BONDS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY WILLCUTT MCKNIGHT LPC

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 BRIDLEBROOK CT
PIKE ROAD AL
36064-2784
US

IV. Provider business mailing address

514 BRIDLEBROOK CT
PIKE ROAD AL
36064-2784
US

V. Phone/Fax

Practice location:
  • Phone: 334-467-7989
  • Fax:
Mailing address:
  • Phone: 334-467-7989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1665
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: