Provider Demographics
NPI:1548708126
Name:MASON, KEVIN ANTHONY (LCPC)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ANTHONY
Last Name:MASON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7827 WISE AVENUE
Mailing Address - Street 2:DUNDALK COUNSELING CENTER
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222
Mailing Address - Country:US
Mailing Address - Phone:410-292-7222
Mailing Address - Fax:410-282-0069
Practice Address - Street 1:7827 WISE AVENUE
Practice Address - Street 2:DUNDALK COUNSELING CENTER
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222
Practice Address - Country:US
Practice Address - Phone:410-292-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5507101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional