Provider Demographics
NPI:1073783742
Name:AYERS, MARY YVONNE (PHD, LCSW-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:YVONNE
Last Name:AYERS
Suffix:
Gender:F
Credentials:PHD, 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:PO BOX 226
Mailing Address - Street 2:
Mailing Address - City:GREAT MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20634-0226
Mailing Address - Country:US
Mailing Address - Phone:301-863-5797
Mailing Address - Fax:
Practice Address - Street 1:22330 CHANCELLORS RUN RD UNIT E
Practice Address - Street 2:
Practice Address - City:GREAT MILLS
Practice Address - State:MD
Practice Address - Zip Code:20634-2423
Practice Address - Country:US
Practice Address - Phone:301-863-5797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-09
Last Update Date:2008-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD068801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical