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General NPI Number Information
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NPI Number | 1992758460
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Entity Type | Individual
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Provider Name | KATHLEEN MARIE BREADY LPC
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Gender | Female
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 4950 PARK RD
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City | CHARLOTTE
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State | NC
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Zip | 28209-3506
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Country | US
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Telephone | 704-523-4881
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Fax | 704-523-4854
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Provider Business Mailing Address
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Address Line | 4402 OVERBECKS LN
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City | WAXHAW
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State | NC
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Zip | 28173-6957
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Country | US
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Telephone | 724-962-7608
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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 | 6741
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License Number State | NC
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