Provider Demographics
NPI:1619443686
Name:STEPHENS, KAITLIN (LCPC, LPC)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 URBANA PIKE STE 205
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:MD
Mailing Address - Zip Code:21754-9406
Mailing Address - Country:US
Mailing Address - Phone:301-259-1132
Mailing Address - Fax:
Practice Address - Street 1:3280 URBANA PIKE STE 205
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:MD
Practice Address - Zip Code:21754-9406
Practice Address - Country:US
Practice Address - Phone:301-259-1132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPMC2148101YM0800X
SCTLC591PC101YM0800X
DCPRC200001315101YP2500X
MDLC11893101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty