Provider Demographics
NPI:1689152654
Name:MICIOTTO, KARA HOPKINS
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:HOPKINS
Last Name:MICIOTTO
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 1:106 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21826-1711
Mailing Address - Country:US
Mailing Address - Phone:443-783-8670
Mailing Address - Fax:
Practice Address - Street 1:1113 HEALTHWAY DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4470
Practice Address - Country:US
Practice Address - Phone:410-334-6961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor