Healthcare Provider Details

I. General information

NPI: 1841616844
Provider Name (Legal Business Name): KATHLEEN L NEISWONGER LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1482 RUSS AVE
WAYNESVILLE NC
28786-4143
US

IV. Provider business mailing address

750 W US HIGHWAY 64
MURPHY NC
28906-8115
US

V. Phone/Fax

Practice location:
  • Phone: 828-452-1395
  • Fax: 828-452-1396
Mailing address:
  • Phone: 828-837-0071
  • Fax: 828-837-5309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA10727
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: