Provider Demographics
NPI:1780807909
Name:REYNOLDS, KATHRYN MARIE (MA, LCPC, NCC, DAPA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARIE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MA, LCPC, NCC, DAPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5114 DORSEY HALL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7878
Mailing Address - Country:US
Mailing Address - Phone:410-689-5181
Mailing Address - Fax:
Practice Address - Street 1:5114 DORSEY HALL DR
Practice Address - Street 2:SUITE A
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7878
Practice Address - Country:US
Practice Address - Phone:410-689-5181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1277101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health