Healthcare Provider Details

I. General information

NPI: 1366723801
Provider Name (Legal Business Name): KATHARINE PAIGE FULTON LCPC, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19506 DOCTORS DR
GERMANTOWN MD
20874-5200
US

IV. Provider business mailing address

22922 LOS ALISOS BLVD STE K360
MISSION VIEJO CA
92691-2856
US

V. Phone/Fax

Practice location:
  • Phone: 301-844-6801
  • Fax:
Mailing address:
  • Phone: 949-326-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: