Provider Demographics
NPI:1851728885
Name:EATON, CATHERINE JANE (LCPC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:JANE
Last Name:EATON
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 1:20402 HONEY CRISP LN
Mailing Address - Street 2:SUITE O
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-4094
Mailing Address - Country:US
Mailing Address - Phone:240-401-8686
Mailing Address - Fax:
Practice Address - Street 1:915 RUSSELL AVE STE B
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-6200
Practice Address - Country:US
Practice Address - Phone:240-401-8686
Practice Address - Fax:888-977-1530
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-04
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5355101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0703389-00Medicaid