Provider Demographics
NPI:1477807550
Name:GARGETT, KATHRYN (LCPC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:GARGETT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MRS
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:GARGETT-JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:941 RUSSELL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-6205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:941 RUSSELL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-6205
Practice Address - Country:US
Practice Address - Phone:301-461-8104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4744101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional