Provider Demographics
NPI:1699081695
Name:KANE-DAVIDSON, BETH ELIZABETH (LCADC)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ELIZABETH
Last Name:KANE-DAVIDSON
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 MONTROSE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4817
Mailing Address - Country:US
Mailing Address - Phone:301-896-6608
Mailing Address - Fax:301-881-7428
Practice Address - Street 1:6001 MONTROSE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4817
Practice Address - Country:US
Practice Address - Phone:301-896-6608
Practice Address - Fax:301-881-7428
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA1707101YA0400X
MDLC2156101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional