Provider Demographics
NPI:1770880577
Name:OWENS, KRISTIAN (LCSW-C)
Entity type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:
Last Name:OWENS
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 1:9500 ARENA DR STE 460C
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-3755
Mailing Address - Country:US
Mailing Address - Phone:301-861-4632
Mailing Address - Fax:
Practice Address - Street 1:9500 ARENA DR
Practice Address - Street 2:SUITE 460-C
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-3755
Practice Address - Country:US
Practice Address - Phone:301-861-4632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16719104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD087227000Medicaid