Provider Demographics
NPI:1285419168
Name:KRUG, EMMA LOUISE (LGPC)
Entity type:Individual
Prefix:MS
First Name:EMMA
Middle Name:LOUISE
Last Name:KRUG
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11708 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21087-1640
Mailing Address - Country:US
Mailing Address - Phone:410-935-2755
Mailing Address - Fax:
Practice Address - Street 1:253 PARADISE RD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-2324
Practice Address - Country:US
Practice Address - Phone:410-273-5681
Practice Address - Fax:410-273-5558
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14257101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health