Provider Demographics
NPI:1174770721
Name:BORNARTH, KATHLEEN MARY (LCMHC)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARY
Last Name:BORNARTH
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:MARY
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:814 E OCEAN HWY
Mailing Address - Street 2:
Mailing Address - City:HOLLY RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28445-8714
Mailing Address - Country:US
Mailing Address - Phone:910-803-0981
Mailing Address - Fax:910-803-0981
Practice Address - Street 1:1061 E OCEAN HWY
Practice Address - Street 2:
Practice Address - City:HOLLY RIDGE
Practice Address - State:NC
Practice Address - Zip Code:28445-8719
Practice Address - Country:US
Practice Address - Phone:910-803-0981
Practice Address - Fax:910-803-0981
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004021101YP2500X
NC2488101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional