Provider Demographics
NPI:1972875573
Name:MALDONADO, KATHIE A (LCPC)
Entity type:Individual
Prefix:MRS
First Name:KATHIE
Middle Name:A
Last Name:MALDONADO
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:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20773-0128
Mailing Address - Country:US
Mailing Address - Phone:301-412-4666
Mailing Address - Fax:
Practice Address - Street 1:6301 IVY LN
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1402
Practice Address - Country:US
Practice Address - Phone:301-412-4666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2397101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional