Provider Demographics
NPI:1043842305
Name:GLACKEN, KATHERINE E (ADT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:GLACKEN
Suffix:
Gender:F
Credentials:ADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21225-3412
Mailing Address - Country:US
Mailing Address - Phone:443-373-8557
Mailing Address - Fax:
Practice Address - Street 1:185 ADMIRAL COCHRANE DR STE 120
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7600
Practice Address - Country:US
Practice Address - Phone:443-440-5780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)