Individual
KATHLEEN DIXON FUNDERBURK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, LMFT, LAC, BAS,
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
977
LA
101YM0800X
Mental Health Counselor
88572
NC
101YP2500X
Professional Counselor
Primary
2680
LA
106H00000X
Marriage & Family Therapist
704
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2680
LICENSED PROFESSIONAL COUNSELOR
LA
01
—
704
LICENSED MARRIAGE AND FAMILY THERAPIST
LA
01
—
88572
NATIONALLY CERTIFIED COUNSELOR
NC
01
—
977
LICENSED ADDICTION COUNSELOR
LA
01
—
S2680
BOARD APPROVED SUPERVISOR FOR COUNSELOR INTERNS
LA
Enumeration date
04/12/2012
Last updated
04/12/2012
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