Provider Demographics
NPI:1366686453
Name:ROCKS, KRISTIN (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:ROCKS
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 S MONTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-3639
Mailing Address - Country:US
Mailing Address - Phone:443-563-3391
Mailing Address - Fax:410-625-4980
Practice Address - Street 1:1800 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5920
Practice Address - Country:US
Practice Address - Phone:410-625-5088
Practice Address - Fax:410-625-4980
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2986101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional