Healthcare Provider Details

I. General information

NPI: 1811458532
Provider Name (Legal Business Name): STEPHANIE KURTYKA LCPAT, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 ROSEMONT AVE
FREDERICK MD
21702-4135
US

IV. Provider business mailing address

17915 LYLES DR
HAGERSTOWN MD
21740-9612
US

V. Phone/Fax

Practice location:
  • Phone: 240-285-9186
  • Fax:
Mailing address:
  • Phone: 301-988-7151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC9422
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberATC230
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: