Provider Demographics
NPI:1649393570
Name:DISCEPOLO, KRISTIN MARIE (LCPC)
Entity type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:MARIE
Last Name:DISCEPOLO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7611 MAPLE AVE
Mailing Address - Street 2:805
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5559
Mailing Address - Country:US
Mailing Address - Phone:202-579-0530
Mailing Address - Fax:
Practice Address - Street 1:962 WAYNE AVE STE 920
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4480
Practice Address - Country:US
Practice Address - Phone:202-579-0530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2208101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health