Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003106295 |
---|---|
Provider Name | Kate Thieda |
First Address | Durham, NC 27705-4640 |
Second Address | Durham, NC 27705-4640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2011 |
Last Update Date | 13/10/2015 |