Healthcare Provider Details

I. General information

NPI: 1851602239
Provider Name (Legal Business Name): CARRIE ANN-LOFDAHL FRESHOUR LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 OLD BRANCH AVE SUITE 212
CLINTON MD
20735-1608
US

IV. Provider business mailing address

7801 OLD BRANCH AVE SUITE 212
CLINTON MD
20735-1608
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-8516
  • Fax: 301-856-8515
Mailing address:
  • Phone: 301-856-8516
  • Fax: 301-856-8515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16134
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: