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General NPI Number Information
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NPI Number | 1700145042
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Entity Type | Organization
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Legal Business Name | CATHLEEN KOUVOLO LLC
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Dates
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Enumeration Date | 05/07/2012
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Last Update Date | 05/07/2012
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Provider Practice Location Address
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Address Line | 9263 MEDICAL PLAZA DR SUITE A
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-7109
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Country | US
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Telephone | 843-377-1600
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Fax | 843-377-1601
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Provider Business Mailing Address
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Address Line | 55 ASHLEY AVE APARTMENT 21
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City | CHARLESTON
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State | SC
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Zip | 29401-1269
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | CATHLEEN KOUVOLO WINCEY
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Credential | MD
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Telephone | 843-614-2675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 31151
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License Number State | SC
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