Healthcare Provider Details

I. General information

NPI: 1003883984
Provider Name (Legal Business Name): KARINA KILLOUGH LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/15/2024
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5427 NC HIGHWAY 49 S STE 105
HARRISBURG NC
28075-7408
US

IV. Provider business mailing address

PO BOX 19305
CHARLOTTE NC
28219-9305
US

V. Phone/Fax

Practice location:
  • Phone: 704-454-7268
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3731
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3731
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3731
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: