MRS. KATHLEEN WAGGONER PETTY (NPI# 1811206204) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811206204 |
| Entity Type | Individual |
| Full Name | MRS. KATHLEEN WAGGONER PETTY |
| Credential | LCSW, CSAC |
| Practice Address |
19441 Golf Vista Plz Suite 110 Lansdowne VA 20176-8269 |
| Mailing Address |
2607 Deerdell Ln Reston VA 20191-2114 |
| Practice Telephone | 7034023080 |
| Mailing Telephone | 7034765822 |
| Enumeration Date | 2010-10-01 |
| Last Update Date | 2010-10-01 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| Street Address |
19441 GOLF VISTA PLZ SUITE 110 |
| City | LANSDOWNE |
| State | VA |
| Zip Code | 20176-8269 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205856515 | Barry R Maharaj | Dentist | 19441 Golf Vista Plz, Suite 130, Lansdowne, VA 20176-8269 | 2006-07-20 |
| 1700320249 | Chelsey Brooks | Counselor | 19441 Golf Vista Plz, Suite 110, Lansdowne, VA 20176-8269 | 2016-12-16 |
| 1144634155 | Loudoun Counseling, LLC | Community/Behavioral Health | 19441 Golf Vista Plz, Suite 110, Lansdowne, VA 20176-8269 | 2014-06-17 |
| 1609204163 | Virginia Eye Center, PC | Ophthalmology | 19441 Golf Vista Plz, Suite 210, Lansdowne, VA 20176-8269 | 2013-10-21 |
| 1023325404 | Sleep Diagnostic Center Inc | Clinic/Center | 19441 Golf Vista Plz, Ste 310, Lansdowne, VA 20176-8269 | 2010-09-08 |
| 1700190253 | Maryam Kathrine Arena | Psychologist | 19441 Golf Vista Plz, Lansdowne, VA 20176-8269 | 2010-07-27 |
| 1376771089 | Laura M Fawcett | Physical Therapist | 19441 Golf Vista Plz, Suite 230, Lansdowne, VA 20176-8269 | 2009-07-01 |
| 1811149784 | Comprehensive Sleep Care Center Inc | Internal Medicine | 19441 Golf Vista Plz, 310, Lansdowne, VA 20176-8269 | 2008-10-22 |
| 1598815524 | Kristen Lundberg Birkland | Marriage & Family Therapist | 19441 Golf Vista Plz, Suite 110, Lansdowne, VA 20176-8269 | 2007-01-11 |
| 1164503876 | Elaine P. Bourdeau | Optometrist | 19441 Golf Vista Plz, Suite 320, Lansdowne, VA 20176-8269 | 2006-10-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053912923 | Timothy Michael Nixon | Pharmacist | 61 Catoctin Circle, Leesburg, VA 20176 | 2020-11-05 |
| 1558996645 | Stacey E Moran | Occupational Therapist | 44124 Woodrige Parkway, Lansdowne, VA 20176 | 2020-03-09 |
| 1710531272 | Joseph H Kasuska Jr. | Specialist/Technologist | 19455 Deerfield Ave. Suite 306, Lansdowne, VA 20176 | 2019-08-01 |
| 1568935849 | Joel Manalang Polintan Jr. | Physical Therapist | 171 Cedarwalk Circle, Leesburg, VA 20176 | 2019-01-09 |
| 1194203026 | Jing Cao | Acupuncturist | 19450 Deerfield Ave Ste 275, Leesburg, VA 20176 | 2018-08-02 |
| 1134648314 | Alaina Marie Gotwalt | Speech-Language Pathologist | 43850 Heatherstone Terrace, Unit 406, Leesburg, VA 20176 | 2017-09-19 |
| 1841717105 | Happy Inhome Care Corp | Respite Care | 722 E Market St Ste 103, Leesburg, VA 20176 | 2017-08-28 |
| 1912423484 | Aaa Good Healthcare LLC | Nursing Care | 722 East Market Street Ne, Suite 102, Leesburg, VA 20176 | 2017-08-16 |
| 1740704253 | Anna Maria Domingo Seaford | Physician Assistant | 19441 Golf Vista Plz Ste 230, Lansdowne, VA 20176 | 2017-07-27 |
| 1710436480 | Reena Patel | Physician Assistant | 224 Cornwall St Nw Leesburg Orthope, Unit 204, Leesburg, VA 20176 | 2016-09-23 |
| Find all providers in zip 20176 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396309100 | Jean Luc Bertier | Counselor | 220 Crawford Ave, Lansdowne, PA 19050-1404 | 2019-04-26 |
| 1932560018 | Charles Williams | Counselor | 115 W Greenwood Ave, Lansdowne, PA 19050-1551 | 2016-03-16 |
| 1295129708 | Campbell Anderson | Counselor | 58 N Lansdowne Ave, S 205, Lansdowne, PA 19050-1953 | 2015-03-23 |
| 1861896276 | Myriam Rosefort | Counselor | 315 Wayne Ave, Lansdowne, PA 19050-1036 | 2014-10-14 |
| 1407267917 | Holly Suzanne Ameen | Counselor | 19420 Golf Vista Plz Ste 250, Lansdowne, VA 20176-8267 | 2014-05-19 |
| 1528397684 | Emris Bernadette Grant | Counselor | 173 Houston Rd, Lansdowne, PA 19050-1709 | 2009-12-18 |
| 1063640381 | Kia Felicia Everett | Counselor | 232 Le Carra Dr, Lansdowne, PA 19050-1718 | 2009-06-25 |
| 1750542460 | Mark Alan Davis Sr. | Counselor | 147 Bryn Mawr Ave, Lansdowne, PA 19050-1806 | 2008-06-24 |
| 1689884926 | Mark Dean | Counselor | 42 Windermere Ave, Lansdowne, PA 19050-1812 | 2007-05-23 |
| 1790826964 | Maria Euterpe Gregory | Counselor | 19 W Stewart Ave, Lansdowne, PA 19050-1905 | 2007-02-09 |
| Find all providers in LANSDOWNE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.