Facts
- Status
- A
- Credential
- LCSW-C
- Type
- Individual
- Enumeration date
- 2013-11-06
- Last updated
- 2013-11-06
Specialties
Licenses
- License MD
- 17212
Location
- Practice location
- 4831 NORRISVILLE RD
- City
- WHITE HALL MD
- Postal code
- 211619678
- Phone
- 443-417-0069
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.