Provider Demographics
NPI:1740837491
Name:WHARTON, KIARA HELEN MARIE (LCPC)
Entity type:Individual
Prefix:MS
First Name:KIARA
Middle Name:HELEN MARIE
Last Name:WHARTON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:KIARA
Other - Middle Name:HELEN MARIE
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 MORGAN RUN
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21863-1262
Mailing Address - Country:US
Mailing Address - Phone:443-614-9968
Mailing Address - Fax:
Practice Address - Street 1:31575 WINTERPLACE PKWY
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1882
Practice Address - Country:US
Practice Address - Phone:443-614-9968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC11504101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid