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General NPI Number Information
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NPI Number | 1386104156
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Entity Type | Individual
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Provider Name | WESLEY LECOUNTE LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 03/20/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 325 GAMBRILLS RD STE F
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City | GAMBRILLS
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State | MD
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Zip | 21054-1102
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Country | US
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Telephone | 443-569-8882
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Fax |
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Provider Business Mailing Address
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Address Line | 923 EASTHAM CT APT 34
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City | CROFTON
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State | MD
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Zip | 21114-1034
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Country | US
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Telephone | 443-970-2689
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 21018
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License Number State | MD
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