Provider Demographics
NPI:1922648567
Name:LAGOW, KATHRYN STANKO (LCPC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:STANKO
Last Name:LAGOW
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 1:6334 GRAY SEA WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-7408
Mailing Address - Country:US
Mailing Address - Phone:410-707-2654
Mailing Address - Fax:
Practice Address - Street 1:6334 GRAY SEA WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-7408
Practice Address - Country:US
Practice Address - Phone:410-707-2654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-12
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC9885101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional