Provider Demographics
NPI:1861974180
Name:DUNAVANT, KATHERINE LYNN (LPC, NCC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LYNN
Last Name:DUNAVANT
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:NC
Mailing Address - Zip Code:27974-6241
Mailing Address - Country:US
Mailing Address - Phone:252-339-4915
Mailing Address - Fax:
Practice Address - Street 1:1400 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4510
Practice Address - Country:US
Practice Address - Phone:252-331-0322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13683101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health