Individual
MS. KATHRYN JO WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW & LAT
Contact information
Practice address
101 N CORONADO DR STE A, SIERRA VISTA, AZ 85635-6359
(520) 343-2940
Mailing address
20 NAVAJO TRL, BISBEE, AZ 85603-1639
(307) 752-7678
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LAT-305
WY
1041C0700X
Clinical Social Worker
Primary
LCSW-579
WY
Other
Enumeration date
04/13/2010
Last updated
08/22/2016
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