Healthcare Provider Details

I. General information

NPI: 1588058663
Provider Name (Legal Business Name): THERESA HUFFINES LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 EASTERN SHORE DR
SALISBURY MD
21804-5934
US

IV. Provider business mailing address

412 PINE BLUFF RD
SALISBURY MD
21801-7111
US

V. Phone/Fax

Practice location:
  • Phone: 410-334-6687
  • Fax:
Mailing address:
  • Phone: 240-486-0694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19075
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: