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NPI Code Detail

MEDICARE: TAHJA-RAE M DICKENSON

MEDICARE: TAHJA-RAE M DICKENSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker29901MD

General Provider Information

NPI Number : 1386317683
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAHJA-RAE M DICKENSON
Provider Business Mailing Address
First Line : 12410 MILESTONE CENTER DR STE 600
Second Line :
City : GERMANTOWN
State : MD
Zip : 20876-7102
Country : US
Telephone Number : 571-457-9306
Fax Number :
Provider Business Practice Location Address
First Line : 12410 MILESTONE CENTER DR STE 600
Second Line :
City : GERMANTOWN
State : MD
Zip : 20876-7102
Country : US
Telephone Number : 571-457-9306
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2021
Last Update Date : 02/04/2026

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Directions to “ TAHJA-RAE M DICKENSON ” Practice Location

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