Provider Demographics
NPI:1134636038
Name:NORMAN, KATHRYN C (ADT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:C
Last Name:NORMAN
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 1:6214 W SHORE DR
Mailing Address - Street 2:
Mailing Address - City:TRACYS LANDING
Mailing Address - State:MD
Mailing Address - Zip Code:20779-2400
Mailing Address - Country:US
Mailing Address - Phone:410-310-0595
Mailing Address - Fax:
Practice Address - Street 1:8737 BROOKS DR STE 108
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7474
Practice Address - Country:US
Practice Address - Phone:800-867-2395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDADT1117101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)