Provider Demographics
NPI:1750850533
Name:WEAVER, MARY CATHERINE (LGPC)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:CATHERINE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 EDMONDSON AVE APT B3
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1825
Mailing Address - Country:US
Mailing Address - Phone:423-863-6651
Mailing Address - Fax:
Practice Address - Street 1:104 E BIDDLE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2755
Practice Address - Country:US
Practice Address - Phone:410-539-1661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP8693101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health