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General NPI Number Information
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NPI Number | 1366723801
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Entity Type | Individual
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Provider Name | KATHARINE PAIGE FULTON LGPC, LGADC
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Gender | Female
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Dates
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Enumeration Date | 08/29/2011
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Last Update Date | 04/07/2020
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Provider Practice Location Address
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Address Line | 1406 CRAIN HWY S
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City | GLEN BURNIE
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State | MD
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Zip | 21061-4058
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Country | US
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Telephone | 410-766-6624
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Fax |
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Provider Business Mailing Address
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Address Line | 915 JACKSON ST
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City | ANNAPOLIS
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State | MD
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Zip | 21403-2112
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Country | US
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Telephone | 707-326-0854
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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