Provider Demographics
NPI:1881002004
Name:KURTZ, DOREATHA
Entity Type:Individual
Prefix:
First Name:DOREATHA
Middle Name:
Last Name:KURTZ
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 1:14701 GOVERNOR ODEN BOWIE DR
Mailing Address - Street 2:ROOM 4416
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3046
Mailing Address - Country:US
Mailing Address - Phone:301-780-7870
Mailing Address - Fax:
Practice Address - Street 1:14701 GOVERNOR ODEN BOWIE DR
Practice Address - Street 2:ROOM 4416
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3046
Practice Address - Country:US
Practice Address - Phone:301-780-7870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC0518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)