Provider Demographics
NPI:1841383379
Name:WIERSEMA, KATHLEEN FAITH (LCPC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:FAITH
Last Name:WIERSEMA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 BALTIMORE AVENUE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740
Mailing Address - Country:US
Mailing Address - Phone:301-704-8120
Mailing Address - Fax:301-779-7000
Practice Address - Street 1:7100 BALTIMORE AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740
Practice Address - Country:US
Practice Address - Phone:301-704-8120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0913101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional