Healthcare Provider Details

I. General information

NPI: 1467718502
Provider Name (Legal Business Name): MICHELLE MORRISON AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10709 BIRMINGHAM WAY
WOODSTOCK MD
21163-1403
US

IV. Provider business mailing address

10709 BIRMINGHAM WAY
WOODSTOCK MD
21163-1403
US

V. Phone/Fax

Practice location:
  • Phone: 410-203-9016
  • Fax: 410-418-4665
Mailing address:
  • Phone: 410-203-9016
  • Fax: 410-418-4665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09325
License Number StateMD

VIII. Authorized Official

Name: MRS. MICHELLE MARIE MORRISON
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW-C
Phone: 410-203-9016