Provider Demographics
NPI:1184087819
Name:LAIDLEY, KATHARINE
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:LAIDLEY
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 1:822 GUILFORD AVE
Mailing Address - Street 2:SUITE 217
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202
Mailing Address - Country:US
Mailing Address - Phone:410-919-9587
Mailing Address - Fax:
Practice Address - Street 1:822 GUILFORD AVE
Practice Address - Street 2:SUITE 217
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3707
Practice Address - Country:US
Practice Address - Phone:410-919-9587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional