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General NPI Number Information
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NPI Number | 1225761513
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Entity Type | Individual
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Provider Name | JUSTIN DAVID MAVINS LMSW
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Gender | Male
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Dates
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Enumeration Date | 07/05/2022
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Last Update Date | 07/05/2022
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Provider Practice Location Address
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Address Line | 6410 DOBBIN RD STE F
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City | COLUMBIA
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State | MD
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Zip | 21045-4774
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Country | US
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Telephone | 240-304-3327
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Fax |
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Provider Business Mailing Address
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Address Line | 7474 GREENWAY CENTER DR STE 200
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City | GREENBELT
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State | MD
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Zip | 20770-3524
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Country | US
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Telephone | 240-304-3327
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Fax | 410-609-7091
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 22926
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License Number State | MD
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