Healthcare Provider Details

I. General information

NPI: 1811811904
Provider Name (Legal Business Name): HALEIGH KATE GROVE LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10005 OLD COLUMBIA RD STE L260
COLUMBIA MD
21046-1722
US

IV. Provider business mailing address

1319 ELM RD
HALETHORPE MD
21227-3943
US

V. Phone/Fax

Practice location:
  • Phone: 443-259-0400
  • Fax: 443-259-0044
Mailing address:
  • Phone: 541-900-0329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP18333
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: