Provider Demographics
NPI:1477336279
Name:COOTS, KAITLYN (LPC)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:COOTS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:MESECHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11270 CHATTERLY LOOP APT 104
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-7857
Mailing Address - Country:US
Mailing Address - Phone:173-187-9607
Mailing Address - Fax:
Practice Address - Street 1:11270 CHATTERLY LOOP APT 104
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-7857
Practice Address - Country:US
Practice Address - Phone:173-187-9607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701012392101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health