Provider Demographics
NPI:1114436870
Name:ROBERTSON, KATHRYN (LCPC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PARK CENTER CT STE 103
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5603
Mailing Address - Country:US
Mailing Address - Phone:410-356-3344
Mailing Address - Fax:410-356-4459
Practice Address - Street 1:1447 YORK RD STE 802
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6017
Practice Address - Country:US
Practice Address - Phone:410-356-3344
Practice Address - Fax:410-356-4459
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6533101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLC6533OtherSTATE LICENSE