Provider Demographics
NPI:1669045712
Name:WILSON-BEAUFORD, KATHYANN P
Entity Type:Individual
Prefix:MRS
First Name:KATHYANN
Middle Name:P
Last Name:WILSON-BEAUFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 PLAZA CIR
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-3608
Mailing Address - Country:US
Mailing Address - Phone:347-593-1281
Mailing Address - Fax:
Practice Address - Street 1:5710 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MD
Practice Address - Zip Code:21225-3641
Practice Address - Country:US
Practice Address - Phone:410-636-5600
Practice Address - Fax:410-636-5600
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)