Provider Demographics
NPI:1407180862
Name:KIDWELL, DEBORAH BRADER (LCPC)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:BRADER
Last Name:KIDWELL
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 1:2141 LOVE POINT RD
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2051
Mailing Address - Country:US
Mailing Address - Phone:410-703-2816
Mailing Address - Fax:
Practice Address - Street 1:112 SAINT CLAIRE PL STE 202
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2193
Practice Address - Country:US
Practice Address - Phone:410-703-2816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4030101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional