Individual
KATHLEEN DIXON FUNDERBURK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, LMFT, LAC, BAS,
Contact information
Practice address
432 HACKER ST, NEW IBERIA, LA 70560-4564
(337) 303-3777
Mailing address
432 HACKER ST, NEW IBERIA, LA 70560-4564
(337) 364-4644
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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