Provider Demographics
NPI:1144763087
Name:CATHRYN WINGATE
Entity Type:Organization
Organization Name:CATHRYN WINGATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WINGATE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:410-975-0105
Mailing Address - Street 1:270 SHAKESPEARE DR
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:277 PENINSULA FARM RD
Practice Address - Street 2:SUITE J
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-1018
Practice Address - Country:US
Practice Address - Phone:410-975-0105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-26
Last Update Date:2016-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0404101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty