Provider Demographics
NPI:1619990066
Name:MIKSZAN, KATHLEEN VERONICA (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:VERONICA
Last Name:MIKSZAN
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 1:10989 SHADOW LANE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044
Mailing Address - Country:US
Mailing Address - Phone:410-997-2133
Mailing Address - Fax:
Practice Address - Street 1:50 WEST MONTGOMERY AVE
Practice Address - Street 2:#110
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:301-251-8965
Practice Address - Fax:301-251-0136
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2203101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional