Provider Demographics
NPI:1629630801
Name:FOLDS, KATHRYN VICTORIA (CO60904245)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:VICTORIA
Last Name:FOLDS
Suffix:
Gender:F
Credentials:CO60904245
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 PACIFIC AVE N
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:WA
Mailing Address - Zip Code:98631-3300
Mailing Address - Country:US
Mailing Address - Phone:360-642-3787
Mailing Address - Fax:
Practice Address - Street 1:124 BOARDWALK DR STE A
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-7994
Practice Address - Country:US
Practice Address - Phone:843-645-2770
Practice Address - Fax:843-645-2771
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60904245101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)