Provider Demographics
NPI:1720490220
Name:BOEHMER, KRISTINE (LCPC)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:BOEHMER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:HALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3510 WORTHINGTON BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7033
Mailing Address - Country:US
Mailing Address - Phone:301-514-2359
Mailing Address - Fax:240-367-9163
Practice Address - Street 1:3510 WORTHINGTON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:MD
Practice Address - Zip Code:21704-7033
Practice Address - Country:US
Practice Address - Phone:301-514-2359
Practice Address - Fax:240-367-9163
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5707101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional