Healthcare Provider Details

I. General information

NPI: 1427080118
Provider Name (Legal Business Name): KATHLEEN BOGGS LCPC, CCDC, CAC-AD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164A WEST MAIN STREET BOX 277
NEW MARKET MD
21774
US

IV. Provider business mailing address

10002 PICEA CT
NEW MARKET MD
21774-2913
US

V. Phone/Fax

Practice location:
  • Phone: 301-518-2289
  • Fax:
Mailing address:
  • Phone: 301-518-2289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1362
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACO324
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC1567
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: