Healthcare Provider Details

I. General information

NPI: 1942709605
Provider Name (Legal Business Name): KATHLEEN HALLIGAN PETERS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 02/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 BESTGATE RD
ANNAPOLIS MD
21401-2117
US

IV. Provider business mailing address

701 BESTGATE RD
ANNAPOLIS MD
21401-2117
US

V. Phone/Fax

Practice location:
  • Phone: 443-906-3506
  • Fax:
Mailing address:
  • Phone: 443-906-3506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLC8145
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: