Provider Demographics
NPI:1841481538
Name:DELONG, KATHERINE MARIE (LAC)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:MARIE
Last Name:DELONG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 W CENTER ST LOT 3
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-8485
Mailing Address - Country:US
Mailing Address - Phone:870-917-2268
Mailing Address - Fax:
Practice Address - Street 1:600 MAIN ST STE V
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4964
Practice Address - Country:US
Practice Address - Phone:501-321-8200
Practice Address - Fax:501-321-8202
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0708043101YP2500X
ARA0407027101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional