Provider Demographics
NPI:1033428065
Name:LELCHOOK, JUDITH VIRGINIA (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:VIRGINIA
Last Name:LELCHOOK
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 JAMAICA DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-2312
Mailing Address - Country:US
Mailing Address - Phone:703-721-1966
Mailing Address - Fax:
Practice Address - Street 1:8830 ORCHARD TREE LN STE 127
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286-2143
Practice Address - Country:US
Practice Address - Phone:443-632-3606
Practice Address - Fax:443-798-7750
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07816101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD27-3530845OtherEIN