Healthcare Provider Details

I. General information

NPI: 1023514882
Provider Name (Legal Business Name): KRISTY LEONE LCPC, LCPAT, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 THAYER CTR STE C
OAKLAND MD
21550-1139
US

IV. Provider business mailing address

4132 E JOPPA RD STE 110-921
NOTTINGHAM MD
21236-2272
US

V. Phone/Fax

Practice location:
  • Phone: 443-464-1639
  • Fax:
Mailing address:
  • Phone: 410-205-6050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLC12081
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberATC299
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: