Provider Demographics
NPI:1427080118
Name:BOGGS, KATHLEEN (LCPC, CCDC, CAC-AD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BOGGS
Suffix:
Gender:F
Credentials:LCPC, CCDC, CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10002 PICEA CT
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-2913
Mailing Address - Country:US
Mailing Address - Phone:301-518-2289
Mailing Address - Fax:
Practice Address - Street 1:164A WEST MAIN STREET
Practice Address - Street 2:BOX 277
Practice Address - City:NEW MARKET
Practice Address - State:MD
Practice Address - Zip Code:21774
Practice Address - Country:US
Practice Address - Phone:301-518-2289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1362101YA0400X
MDACO324101YA0400X
MDLC1567101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional