Healthcare Provider Details

I. General information

NPI: 1760109698
Provider Name (Legal Business Name): JAMIAH PATRICE ELMORE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 TELFAIR BLVD
CAMP SPRINGS MD
20746-5276
US

IV. Provider business mailing address

915 CARNABY ST
STAFFORD VA
22554-9442
US

V. Phone/Fax

Practice location:
  • Phone: 571-276-4578
  • Fax:
Mailing address:
  • Phone: 571-276-4578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number257401
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904014586
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: