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Individual

TARA LYNN KETTERINGHAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCPC

Contact information

Practice address
5412 OLD NATIONAL PIKE, FREDERICK, MD 21702-3640
(240) 490-0256
Mailing address
5412 OLD NATIONAL PIKE, FREDERICK, MD 21702-3640
(240) 490-0256

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LC12334
MD
101YP2500X
Professional Counselor
LGP9228
MD

Other

Enumeration date
04/09/2019
Last updated
02/21/2023
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