=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376820811
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHI J BIVENS LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2011
-----------------------------------------------------
Last Update Date | 01/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 619 OAKLAND ST
-----------------------------------------------------
City | HENDERSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28791-3645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-595-4300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 57 MASTERS VIEW DR
-----------------------------------------------------
City | ETOWAH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28729-7769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-595-4300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 10521
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------