Provider Demographics
NPI:1225586639
Name:WASSON, WILLIAM (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:WASSON
Suffix:
Gender:M
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 1:3319 W BELVEDERE AVE
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5143
Mailing Address - Country:US
Mailing Address - Phone:443-884-7521
Mailing Address - Fax:410-542-6467
Practice Address - Street 1:3319 W BELVEDERE AVE
Practice Address - Street 2:ATTN: CREDENTIALING
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5143
Practice Address - Country:US
Practice Address - Phone:443-884-7521
Practice Address - Fax:410-542-6467
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD158421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical