MEDICARE: MRS. CORNEALIUS LASHAN STAMPS LCSW-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW005048	GA
2	1041C0700X	Clinical Social Worker	22212	MD

General Provider Information

NPI Number	:	1962709659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CORNEALIUS LASHAN STAMPS LCSW-C

Provider Business Mailing Address
First Line	:	9300 DEWITT LOOP
Second Line	:
City	:	FORT BELVOIR
State	:	VA
Zip	:	22060-5285
Country	:	US
Telephone Number	:	706-825-5158
Fax Number	:

Provider Business Practice Location Address
First Line	:	6710 OXON HILL RD STE 210
Second Line	:
City	:	OXON HILL
State	:	MD
Zip	:	20745-1124
Country	:	US
Telephone Number	:	240-863-2820
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2011
Last Update Date	:	05/15/2019

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