Healthcare Provider Details

I. General information

NPI: 1659191419
Provider Name (Legal Business Name): KEVIN NUGENT LGPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TALBOT ST
EASTON MD
21601-3525
US

IV. Provider business mailing address

300 TALBOT ST
EASTON MD
21601-3525
US

V. Phone/Fax

Practice location:
  • Phone: 410-822-1018
  • Fax: 410-820-5884
Mailing address:
  • Phone: 410-822-1018
  • Fax: 410-820-5884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP15654
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: