Individual
KATHLEEN E ESTABROOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PCC-S,LSW,LICDC
Contact information
Practice address
515 MARTIN DR, XENIA, OH 45385-1615
(937) 352-2908
(937) 352-2930
Mailing address
515 MARTIN DR, XENIA, OH 45385-1615
(937) 352-2908
(937) 352-2930
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
E-3754-SUPV
OH
1041C0700X
Clinical Social Worker
S-13433
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11823305
CAQH #
—
Enumeration date
08/22/2006
Last updated
02/15/2012
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