Provider Demographics
NPI:1760605687
Name:CHILDS, KATHLEEN ELIZABETH (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ELIZABETH
Last Name:CHILDS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:ELIZABETH
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:5074 DORSEY HALL DR STE 104
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7794
Mailing Address - Country:US
Mailing Address - Phone:301-442-7015
Mailing Address - Fax:
Practice Address - Street 1:5074 DORSEY HALL DR STE 104
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7794
Practice Address - Country:US
Practice Address - Phone:301-442-7015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional