Provider Demographics
NPI:1730245887
Name:LATTEA, KATHLEEN M (LCPC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:LATTEA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16209 OLD FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-3346
Mailing Address - Country:US
Mailing Address - Phone:301-748-2308
Mailing Address - Fax:301-662-6966
Practice Address - Street 1:1011 E PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-3119
Practice Address - Country:US
Practice Address - Phone:301-662-6966
Practice Address - Fax:301-662-6966
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2008-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0367101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional