1124151485 NPI number — MRS. MELIKA DORROH LCSW-C

Table of content: MRS. MELIKA DORROH LCSW-C (NPI 1124151485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124151485 NPI number — MRS. MELIKA DORROH LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DORROH
Provider First Name:
MELIKA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORGAN
Provider Other First Name:
MELIKA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124151485
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5531 SHALLOW RIVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20735-1419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-455-3888
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8901 WISCONSIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20889-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-295-5925
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  12010 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 12010 . This is a "CLINICAL SOCIAL WORK LICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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