Healthcare Provider Details

I. General information

NPI: 1730854969
Provider Name (Legal Business Name): KRISTA MCGOWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 N CHARLES ST
TOWSON MD
21204-3780
US

IV. Provider business mailing address

35 NAKOTA CT
MIDDLE RIVER MD
21220-3664
US

V. Phone/Fax

Practice location:
  • Phone: 443-809-4130
  • Fax:
Mailing address:
  • Phone: 609-408-8579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC14092
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: