Provider Demographics
NPI:1982007266
Name:PANOS, KRISTEN E (LCPC)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:E
Last Name:PANOS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:ELIZABETH
Other - Last Name:NORRIS (MARRIED NAME)
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:10630 LITTLE PATUXENT PKWY STE 209
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-6278
Mailing Address - Country:US
Mailing Address - Phone:410-740-8068
Mailing Address - Fax:
Practice Address - Street 1:10630 LITTLE PATUXENT PKWY STE 209
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-6278
Practice Address - Country:US
Practice Address - Phone:410-740-8068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5609101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional