Provider Demographics
NPI:1366723801
Name:FULTON, KATHARINE PAIGE (LGPC, LGADC)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:PAIGE
Last Name:FULTON
Suffix:
Gender:F
Credentials:LGPC, LGADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-2112
Mailing Address - Country:US
Mailing Address - Phone:707-326-0854
Mailing Address - Fax:
Practice Address - Street 1:1406 CRAIN HWY S
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4058
Practice Address - Country:US
Practice Address - Phone:410-766-6624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health