Provider Demographics
NPI:1063663870
Name:WASHINGTON, DAPHNE LAVONE BLICK (PHD,LCPC,NCC,DCC)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:LAVONE BLICK
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:PHD,LCPC,NCC,DCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 CAMPBELL MEADOWS ROAD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4993
Mailing Address - Country:US
Mailing Address - Phone:443-394-0007
Mailing Address - Fax:
Practice Address - Street 1:9650 SANTIAGO ROAD, SUITE 101
Practice Address - Street 2:STEVENS FOREST PROFESSIONAL CENTER
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:410-995-5587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1128101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional