Individual
MRS. KATHLEEN KELLY LAVINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
949 GORSUCH AVE, BALTIMORE, MD 21218-3602
(410) 467-4121
(410) 467-6709
Mailing address
949 GORSUCH AVE, BALTIMORE, MD 21218-3602
(410) 467-4121
(410) 467-6709
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCA454
MD
101YP2500X
Professional Counselor
Primary
LC1666
MD
Other
Enumeration date
09/27/2011
Last updated
09/27/2011
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