Provider Demographics
NPI:1548670516
Name:DOVE, KATHRYN MILLER
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:MILLER
Last Name:DOVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7417 MINE SHAFT RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6023
Mailing Address - Country:US
Mailing Address - Phone:919-740-1224
Mailing Address - Fax:
Practice Address - Street 1:3800 HILLSBOROUGH ST
Practice Address - Street 2:LEDFORD HALL
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5237
Practice Address - Country:US
Practice Address - Phone:919-760-8022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-14-15190103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst