Provider Demographics
NPI:1447329289
Name:ROUNDTREE, KATHRYN YVONNE (LCSW)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:YVONNE
Last Name:ROUNDTREE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 W NC HIGHWAY 54
Mailing Address - Street 2:SUITE 207
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5577
Mailing Address - Country:US
Mailing Address - Phone:919-401-2933
Mailing Address - Fax:919-401-2994
Practice Address - Street 1:1502 W NC HIGHWAY 54
Practice Address - Street 2:SUITE 103
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5571
Practice Address - Country:US
Practice Address - Phone:919-403-2122
Practice Address - Fax:919-401-4993
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0040231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003081Medicaid
2876528AMedicare ID - Type Unspecified