Provider Demographics
NPI:1902177918
Name:STINES, KATHLEEN (LICSW LICSW-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:STINES
Suffix:
Gender:F
Credentials:LICSW LICSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12017 SWALLOW FALLS CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7814
Mailing Address - Country:US
Mailing Address - Phone:301-520-1496
Mailing Address - Fax:
Practice Address - Street 1:12017 SWALLOW FALLS CT
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7814
Practice Address - Country:US
Practice Address - Phone:301-520-1496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC302818104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker