Provider Demographics
NPI:1336995703
Name:WILSON, KAITLYN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 RITCHIE HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2561
Mailing Address - Country:US
Mailing Address - Phone:410-626-7800
Mailing Address - Fax:
Practice Address - Street 1:1517 RITCHIE HWY STE 201
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2561
Practice Address - Country:US
Practice Address - Phone:410-626-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD283331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical