Healthcare Provider Details

I. General information

NPI: 1134636038
Provider Name (Legal Business Name): KATHRYN C NORMAN ADT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 01/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8737 BROOKS DR STE 108
EASTON MD
21601-7474
US

IV. Provider business mailing address

6214 W SHORE DR
TRACYS LANDING MD
20779-2400
US

V. Phone/Fax

Practice location:
  • Phone: 800-867-2395
  • Fax:
Mailing address:
  • Phone: 410-310-0595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberADT1117
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: