Provider Demographics
NPI:1336379239
Name:MCCONNELL, ERIN KATHLEEN (ATR)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:KATHLEEN
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 PUTTY HILL AVE
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-4124
Mailing Address - Country:US
Mailing Address - Phone:240-751-6405
Mailing Address - Fax:
Practice Address - Street 1:260 GATEWAY DR
Practice Address - Street 2:BLDG. 1, SUITE 15B
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4268
Practice Address - Country:US
Practice Address - Phone:240-751-6405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-26
Last Update Date:2009-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09-124101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health