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General NPI Number Information
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NPI Number | 1477802379
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Entity Type | Individual
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Provider Name | KATHERINE BOTTENUS JUDD LPC-A
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Gender | Female
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Dates
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Enumeration Date | 09/06/2012
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 1301 CAROLINA ST SUITE 114
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City | GREENSBORO
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State | NC
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Zip | 27401-1032
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Country | US
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Telephone | 336-542-2060
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Fax |
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Provider Business Mailing Address
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Address Line | 4917 OLD TOWNE VILLAGE CIR
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City | PFAFFTOWN
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State | NC
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Zip | 27040-9805
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Country | US
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Telephone | 336-416-0742
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A8596
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License Number State | NC
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